BERKELIY 

LIBRARY 


or 

CAUKJBWA 


F*OM   THE   OPTOMCTRIC   LIIHARY 
Of        

MONROE    JEROME    HIRSCH 


THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 


•  GIVEN  WITH  LOVE  TO  THE 
OPTOMETRY  LIBRARY 

BY 
MONROE  J.  HIRSCH,  O.D.,  Ph.D. 


RKI! 

JRA 


A  SYSTEM  OF 


MATURE    MEDICINE 


AS  TAUGHT  IN 


McCoRMicK  MEDICAL  COLLEGE 

CHICAGO,  ILLINOIS 

FOUNDED  1893  CHARTERED  IN  ILLINOIS 


By  Charles  McCormick,  M.  D.,  President 


VOLUME  I 
OPTICS  and  OPHTHALMOLOGY 


PUBLISHED  BY 

McCormick  Medical  College 
Chicago,  111. 


1916 


/ 


COPYRIGHT  1916 

By  Charles  McCormick 


V.  I 


Part  I 
PHYSICAL  OPTICS 


CONTENTS,  PART  I. 
NINETY-SIX  ILLUSTRATIONS 

Preliminary  Remarks   .  .    5 

I.  Refraction  and  Reflection  by  Plane  Parallel 

Surfaces    13 

II.  Refraction  and  Reflection,  by  Plane  Surfaces 

Forming  Prisms    21 


III.  Refraction  and  Reflection  by 

Single  Curved  Surfaces..   29 

IV.  Refraction  and  Reflection  by 

Piano-Convex   Lenses    .  .   4-1 


V.  Refraction  and  Reflection  by 

Piano-Concave  Lenses  . . 

VI.  Refraction  and  Reflection  by 

Bi-Convex   Lenses    57 

VII.  Refraction       and 

Reflection  by 
B  i-C  o  n  c  a  v  e 
Lenses  65 

VIII.  Refraction       and 

Reflection      by 
Meniscus   Lens- 
es       69 

IX.  Refraction       and 

Aberration  o  f 
Tri-Curved  and 
Other  Lenses.  81 

X.  Neutralization  of   Lens- 

es, Pres  cription 
Writing,  Transposi- 
tion and  Analysis..  87 
XL  Physical  Construction 
of  the  Eyes,  Stand- 
ard and  Defective..  !>>'! 

XII.  Physics  of  Retiryascopy  and  Why  It 

Will  Not  WTork  Physiologically.  .101 

XIII.  Exercises    Involving   the    Principles 

.  of  Physical  Optics • 107 


1.00 


/.SO 


PRELIMINARY  REMARKS. 

In  the  spring  of  1895  I  published  a  booklet  of  100  pages  entitled  "Prac- 
tical Optics,  for  Beginnners,"  in  which,  after  calling  attention  to  the  effects 
on  the  general  nervous  system  from  the  efforts  to  overcome  hyperopia,  I 
concluded  with  the  following  paragraph : 

''It  is  not  unreasonable  to  assert  that  a  very  large  per  cent,  of  nervous 
'diseases'  may  be  absolutely  cured  without  the  aid  of  medicines,  other  than 
a  pair  of  properly  fitted  spectacles." 

In  1898  I  published  "Optical  Truths"  in  which  I  gave  clinical  experiences 
with  epilepsy,  female  ills,  and  all  sorts  of  nervous  "diseases,"  explained  how 
the  nerve  supply  and  demand  could  be  measured,  showed  the  fallacy  of 
prisms  as  therapeutic  agents,  exploited  the  straightening  of  cross-eyes  with- 
out operation  and  exposed  ophthalmic  charlatans  and  their  practices.  For 
all  of  which  I  was  roundly  abused  by  some  of  the  so-called  "authorities." 

In  1900  I  began  the  publication  of  the  "Ophthalmologist,"  a  monthly, 
which  was  continued  for  ten  years,  in  which  I  had  the  means  of  answering 
critics  and  spreading  good  tidings  as  I  discovered  them. 

In  1905  I  published  "Neurology  and  Metaphysics,"  a  large,  illustrated 
volume,  in  which  were  recorded  in  detail  many  discoveries  beyond  the  field 
of  Ophthalmology  and  the  manner  in  which  it  was  received  was  most 
gratifying.  I  still  receive  letters,  almost  weekly,  from  those  who  have  tried 
out  the  propositions  and  found  they  all  worked. 

In  1906  a  second  edition  of  "Optical  Truths,"  rewritten  and  enlarged, 
was  published  and  thousands  of  them  'are  in  the  hands  of  practitioners  who 
have  expressed  their  satisfaction  over  its  comprehensiveness,  while  the  pub- 
lishers of  "authoritative"  text-books  complain  that  the  demand  for  them  has 
"fallen  off  very  much  for  some  unaccountable  reason."  The  fact  that  they 
are  ambiguous  and  mere  reiterations  of  one  another  is  one  of  the  reasons  for 
this  falling  off  in  sales  and  it  is  highly  probable  that  "Optical-  Truths"  has 
had  much  to  do  with  it. 

In  1907  my  "Synopsis  of  Neurology"  was  published,  in  pocket  form,  for 
the  benefit  of  students  and  practitioners,  and  it  has  been  called  "the  biggest 
little  book"  by  hundreds  who  have  written  their  appreciation. 

January  1910  the  publication  of  Mature  Medicine  was  begun  as  a 
quarterly  "Circular  of  Information"  to  the  profession  and  the  public.  Hun- 
dreds of  thousands  of  copies  are  circulated  every  year  and  the  results 
have  been  most  encouraging.  First,  we  have  the  evidence  in  letters  from 
prominent  laymen  and  physicians  expressing  appreciation  of  our  outspoken 


6  A  SYSTEM  OF  MATURE  MEDICINE 

efforts  in  enlightening  the  public  generally  and  themselves  in  particular ;  sec- 
ond we  have  incurred  the  hostility  of  the  Medical  Trust,  which  is  interested 
in  keeping  the  public  frightened,  the  Newspaper  Trust,  the  Religious  Trust 
and  the  Political  Trust,  all  of  whom  are  allies  of  the  Medical  Trust,  and  they 
have  slandered,  ridiculed,  "investigated,"  "exposed,"  "legislated"  and  other- 
wise discriminated  against  us,  all  with  about  the  same  effect  rain  has  on  a 
duck.  All  of  which  reminds  me  of  the  parable  of  the  wise  man  and  the 
foolish  man  who  builded  their  houses  upon  a  rock  and  upon  the  sand.  See 
Matthew  VII,  25-27. 

This  book  is  the  first  volume  of  a  review  of  what  I  have  gathered  in  the 
past  twenty-five  years  from  practice,  teaching,  writing  and  applying  myself 
to  the  study  of  things  as  they  are,  instead  of  as  self-styled  "scientific  authori- 
ties" would  have  us  all  believe.  From  my  past  experiences  I  am  as  s.ure  of  a 
welcome  for  the  work  as  I  am  sure  of  the  pleasure  and  more  substantial 
benefits  in  the  preparation  of  the  copy. 


My  work  was  begun  because  of  the  false  pretenses  of  the  old  schools 
of  medicine  and  other  sophistical  sects  and  their  antagonism  has  been  my 
constant  inspiration  aided  and  abetted  by  my  own  enthusiasm  over  the  truths 
I  have  found  and  proved. 

Many  years  ago  I  asserted :  "Nervous  strain,  through  defective  eyes  is 
the  Primary  cause  of  at  least  eighty-five  per  cent,  of  all  human  ills."  I  have 
never  had  occasion  to  recant.  On  the  contrary,  the  opprobrium  heaped  upon 
me  by  my  contemporaries  spurred  me  to  pile  up  the  proofs,  which  I  did  so 
effectively  that  one  of  my  friends,  the  enemy,  later  asserted  that  "eye  strain 
is  the  Cause  of  eighty-five  per  cent,  of  all  ills."  His  assertion  was  accepted 
as  true,  because  he  had  an  "international  reputation" — as  a  compiler  of 
dictionaries.  The  statement  is  obviously  false,  while  I  shall  show  that  my 
reference  to  it  as  a  primary  cause  is  rational ;  and  I  will  also  show  that  no 
system  of  eye  practice  is  complete  until  it  embraces  a  theoretical  and  practical 
knowledge  of  the  secondary,  or  contributing  causes,  how  they  may  be  pro- 
duced directly  and  indirectly  by  the  primary  cause,  how  they  may  be  prod- 
ucts of  habits,  occupation,  and  other  voluntary  conditions,  or  from  those 
over  which  the  individual  has  no  control.  It  should  be  apparent  to  anyone 
that  if  a  nervous  system  is  depleted  from  any  of  the  following  causes :  con- 
genital, infection,  malnutrition,  physical  shock,  mental  shock,  physiological 
strain,  mental  strain,  habits,  occupation  or  atmospheric  influences,  or  a  com- 
bination of  two  or  more  of  them,  the  correction  of  the  physiological  demand 
through  the  eyes  would  not  be  sufficient  to  restore  physiological  equilibrium, 
even  if  it  affords  partial  relief  to  the  afflicted. 

It  is  my  purpose  to  cover  not  only  that  part  of  physical  optics  which 
relates  to  the  practice  of  ophthalmology,  and  do  it  a  little  better  than  it  has 
ever  been  done  before,  but  to  go  into  considerable  detail  with  reference  to 
the  origin  and  exhibits  of  the  contributing  causes,  together  with  methods  of 
procedure  in  the  measurements,  charges,  discounts  and  analysis  of  all  sorts 
of  symptoms,  mental  and  physiological. 


INTRODUCTION 


The  query  "What  is  light?"  has  agitated  the  brains  of  investigators  for 
many  centuries,  yet  it  is  still  an  open  question  in  some  particulars. 
There  have  been  exploited  three  theories  of  light: 

(a)  The  Emission  or  Corpuscular,  in  which,  it  was  explained  by  Newton, 
to  consist  of  "elastic  particles  of  inconceivable  minuteness,  shot  out  with  in- 
conceivable  rapidity   by  luminous  bodies."     He  justified   his'  belief  by  the 
facts   illustrated   in   reflection   and   transmission   of  light  with   reference  to 
transparent  materials,  such  as  glass,  and  by  the  luminosity  of  any  solid  body 
when  heated ;  as  the  heat  radiated  so  did  the  light ;  the  latter  being  perceptible 
at  a  greater  distance,  signified  a  different  property.    This  theory  did  not  ex- 
plain what  light  is  nor  did  it  explain  phosphorescence,  nor  other  exhibits  of 
luminosity,  and  after  it  dawned  upon  the  world  that  Newton  was  not  infal- 
lible, the  theory  was  repudiated.     But  that  does  not  prove  he  was  wrong. 

As  a  substitute,  a  theory  by  Thomas  Young,  an  Englishman,  born  in  1773, 
was  adopted  after  much  acrimonious  bickering  among  the  scientists. 

(b)  The  Undulatory  or  Wave  theory  propounded  by  Young  and  gen- 
erally accepted  is  that  "when,  under  certain  primary  conditions,  a  disturbance 
occurs  in  the  'ether'  light  is  promulgated  in  the  form  of  infinitely  small  waves, 
up  and  down."     (Just  what  "up"  and  "down"  is  in  universal  space  he  did  not 
tell).     This  theory  has  been  elaborated  by  others,  who  noted  sound  waves 
and  those  caused  by  dropping  pebbles  in  the  water  until  plausible  explana- 
tions of  many  light  phenomena  became  popular. 

(c)  Then  came  the  proposition  that  "Light  is  really  in  the  nature  of 
a  periodical  electro-magnetic  polarity  of  the  luminiferous  ether."     It  is  gen- 
erally passed  because  it  is  too  indefinite. 

Many  experiments  with  light  have  been  made.  Newton  found  it  to  be  a 
composite  by  developing  colors  in  passing  light  through  a  prism.  Then  the 
wave  theorists  declared  the  reason  for  the  existence  of  colors  is  because: 
"Light  which  emanates  from  the  sun,  and,  indeed,  from  any  incandescent 
body,  is  not  of  one  wave  length,  but  is  composed  of  a  confused  mixture  of 
waves  of  every  length  down  to  a  limit  fixed  by  the  temperature  of  the 
luminous  body  and  that  differences  of  wave  lengths  affect  the  optic  nerve  so, 
as  to  produce  a  sensation  of  difference  in  color."  To  illustrate,  they  take  as 
a  unit  the  10,000th  part  of  a  millimeter,  then,  "light  of  wave-length  7  units 
will  appear  intensely  red ;  one  of  6  units  will  be  salmon-yellow ;  5  will  be 
green ;  4  blue ;  less  than  4  it  will  be  invisible." 

This  reads  fairly  well ;  but  there  is  a  discrepancy  which  no  theorist  has 
ever  explained.  Possibly  they  have  never  observed  it:  Chemically  glass  be- 
longs to  that  large  class  of  combinations  called  salts,  it  being  a  mixture 
of  two  or  more  silicates.  When  silica,  or  silicic  acid,  is  combined  with  a 
base,  such  as  calcium  oxide,  or  lead  oxide,  a  silicate  is  formed.  The  most 
common  kind  of  glass  is  made  by  melting  together  silica  in  the  form  of  sand, 
lime-stone,  or  calcium  carbonate,  and  sodium  carbonate,  or  soda,  the  product 
being  a  silicate  of  sodium  and  calcium.  The  sodium  may  be  replaced  by 
potassium,  either  partly  or  entirely,  and  the  calcium  by  lead.  The  propor- 
tions for  the  different  kinds  of  glass  have  been  established  by  experiment.  A 
peculiar  difference  in  the  action  of  glass  on  light  is  found  when  lead  is  sub- 
stituted for  calcium.  The  index  of  refraction  remains  almost  unchanged  but 


A  SYSTEM  OF  MATURE  MEDICINE 


the  capacity  for  dispersion  is  almost  doubled,  therefore  the  dispersion  of  a 
20-degree  prism  of  calcium  glass  may  be  neutralized  by  a  10-degree  prism  of 
lead  glass,  bases  opposite,  while  the  refraction  of  the  calcium  glass  is  only 
half  neutralized.  It  is  this  chemical  property  which  facilitates  the  manu- 
facture of  achromatic  lenses.  The  point  which  has  been  overlooked  by  the 
wave  theorists  is  that  it  is  evidently  not  the  mechanical  structure  but  the 
chemistry  of  the  combination  of  prisms  which  disperses  and  reunites  the 
colors.  This  is  the  basis  of  our  theory  of  color  blindness,  which  subject 
will  be  treated  in  its  place. 

Thus  the  wave  theory  gets  a  blow  in  the  solar  plexus.  Tyndall  wrote : 
"No  human  authority,  however  high,  can  maintain  itself  against  the  voice 
of  Nature  speaking  through  experiment."  He  was  referring  to  Newton's 
theory  and  to  the  sarcasm  of  Mr.  H.  Broughan,  in  the  Edinburgh  Review, 
against  Young,  which  prevented  the  acceptance  of  his  wave  theory  for  more 
than  twenty  years. 

In  view  of  the  discrepancies  in  all  of  the  theories  so  far  advanced,  when  put 
to  severe  tests,  we  have  evolved  the  following  definition  of  light  as  a  matter 
of  convenience  and  comprehension  in  introducing  the  subject  to  the  student: 

The  word  light  refers,  physically,  to  anything,  Natural  or  artificial, 
which  renders  objects  visible.  Regarded  as  a  substance,  it  is  a  product  of 
chemical  or  mechanical  agitation,  whether  it  comes  to  us  in  the  form  of  in- 
finite atoms  or  otherwise  is  of  no  moment  in  the  practice  of  ophthalmology. 

Natural  light  is  an  infinite  product.  Its  influence  on  planetary  develop- 
ments, on  their  movements,  on  plant  and  animal  life,  is  beyond  human 
comprehension.  It  exhibits  most  vividly  in  sunlight ;  next  in  importance, 
probably,  is  lightning;  then  the  vital  brilliancy  of  the  fire-fly,  glow-worm  and 
other  species;  finally  the  phosphorescent  luminosity  of  decaying  matter. 

Artificial  lights  are  finite  products,  beginning  with  the  torch  of  the 
aborigine,  followed  by  the  tallow  dip  and  other  oils ;  then  the  gas  period ; 
now  electricity.  The  possible  products  of  chemistry  and  mechanics  are 
almost  limitless. 

The  purposes  of  this  book  confine  the  author  to  those  facts  which  are 
demonstrable  beyond  question;  hence  speculation  is  left  to  those  who  choose 
mystery  over  mathematics.  It  is  not  intended  that  it  shall  be  a  popular  book. 
It  is  hoped,  however,  to  make  it  a  work  that  will  help  some  people  to  think 
and  encourage  them  to  persist  in  their  efforts  to  help  themselves  and  others. 
It  shall  not  be  a  dry  or  cold  book.  It  will,  probably,  be  hot  in  places. 

In  teaching  we  believe  simplicity  and  directness  are  indispensable  to 
comprehensiveness.  In  all  of  the  twenty-three  years  of  school  work  we 
have  practiced  this  belief  and  -the  results  have  been  satisfactory.  A  teacher 
must  get  close  to  his  pupils.  Few  dare  do  this  because  of  a  fear  of  the 
"familiarity"  which  "breeeds  contempt."  Experience  has  taught  us  that  the 
student  who  grows  contemptuous  when  his  teacher  appears  to  recognize  him 
as  human,  is  not  of  a  calibre  to  be  feared. 

The  laws  of  refraction,  as  well  as  other  matters,  will  be  presented  in 
consecutive  order.  No  attempt  will  be  made  to  be  artistic  in  text  or  illus- 
trations. The  latter  will  fit  the  former,  and  the  student  who  reads  should 
measure  to  be  sure  of  an  understanding. 


INTRODUCTION 


Systematic  study  is  the  only  method  by  which  one  can  attain  competence 
in  any  line  of  work. 

Nature  does  things  on  a  fixed  plan  and  if  we  follow  it  as  nearly  as  pos- 
sible we  will  acquire  information  more  easily  and  completely.  I  have  named 
the  method  I  employ  the  duality  system.  I  often  use  an  apple  in  illustration 
before  a  class,  dividing  it  in  halves,  then  placing  the  halves  together,  turn 
it  half  around  and  make  a  second  division,  vertically,  at  right  angles  with  the 
first  cut;  then,  putting  the  four  pieces  together  and  turning  it  on  its  side, 
another  cut  through  the  middle  makes  eight  pieces.  As  no  other  single  cut 
will  double  the  number  of  pieces  again,  it  is  a  good  illustration  of  the  limits 
of  laws  and  suggests  that  when  we  have  reduced  any  subject  to  eight  parts 
by  the  duality  system,  we  are  in  a  fair  way  to  get  all  there  is  to  it.  The 
same  subject  may  be  subdivided  in  different  diagrams,  and  it  is  often  ad- 
visable to  do  it,  because  of  the  possibility  of  making  mistakes  in  classifica- 
tion. The  following  specimens  may  help  the  student  grasp  the  idea.  He 
will  never  master  it  absolutely.  I  never  have  attained  and  do  not  think  it 
possible  for  anyone  to  attain  perfection  in  it;  but  it  is  a  wonderful  help  and 
is  as  interesting  as  a  game  of  chess : 


Natural. 


r  Composition  ..... 


)  Color 


Optics. 


Light. 


Artificial. 


Positive. 


Refraction. 


Negative. 


[  Vitality {  Physiological 

I  Metaphysical 

rAncient (  Torch 

J  I  Oil 

\Modern (Gas 

I  Electricity 

r  Simple....  (Transmission 

\  Reflection 

I  Compound (  F°ci 

(  Aberration 

(-Regular ...(Spherical 

J  (  Cylindrical 

I  Irregular (  Design 

(  Accident 

Then  we  take  each  word  and  investigate  it  in  search  for  suggestions, 
thus: 

Optics  is  a  branch  of  scientific  study  which  treats  of  Light  and  Refrac- 
tion, from  simple  principles  to  Astronomy,  physically ;  to  Ophthalmology, 
physiologically ;  to  General  Knowledge,  intellectually ;  and  to  Health  and 
Happiness,  compositely. 

Light  is  luminosity,  either  direct,  from  luminous  bodies,  or  indirect, 
by  reflection  from  objects  not  luminous;  it  not  only  enables  those  who  can 
see  to  do  so,  but  it  has  an  influence  on  the  growth  of  vegetable  and  animal 
life,  and  is  the  greatest  aseptic  and  antiseptic  known. 

Natural  light  comprises  sunlight,  lightning,  phosphorescent  glows,  and 
the  physiological  exhibits  of  some  bugs,  worms  and  birds. 

The  composition  of  natural  light  is  a  combination  of  elements  repre- 
sented by  colors  red  and  green,  yellow  and  violet ;  the  first  and  second  are 


10  A  SYSTEM  OF  MATURE  MEDICINE 

complementary  to  each  other  and  the  third  and  fourth  bear  the  same  rela- 
tion. The  spectral  colors  are  products  of  these  four. 

Vitality  of  light  is  that  physical  and  metaphysical  influence  which  affects 
life  and  mental  moods. 

Artificial  lights  lack  many  of  the  qualities  of  the  natural,  but  they  offer 
evidence  of  mankind's  capacity  to  imitate  Nature  and  afford  means  of  con- 
tinuing work  during  hours  when  the  natural  facilities  are  supplying  our 
neighbors  on  the  other  side  of  the  earth. 

Ancient  artificial  lights  were  the  torch  and  oils  probably  ignited  with 
a  flint  and  steel. 

Modern  artificial  lights,  gas  and  electric,  are  testimonials  of  the  ad- 
vancement of  the  race. 

Refraction  of  light  is  the  change  of  direction  by  means  of  transparent 
mediums  presented  at  proper  angles  so  that  the  change  occurs  during  the 
passage  of  rays  through  it. 

Positive  refraction  is  a  subdivision  of  the  subject  for  convenience  and 
means  that  the  change  of  course  is  in  a  certain  direction,  nearer  the  per- 
pendicular to  the  refracting  surface. 

Simple  refraction  refers  merely  to  the  changes  in  course  during  trans- 
mission or  by  reflection  from  a  surface. 

Compound  refraction  includes  the  focusing  of  many  rays  at  a  point  or 
a  line,  or  sending  them  away  from  a  medium  as  if  they  came  from  a  point  or 
a  line;  also  the  'chromatic  and  spherical  aberration  which  is  associated  with 
refraction. 

Negative  refraction  is  a  classification  directly  opposite  to  the  posi- 
tive. 

Regular  refraction  is  that  accomplished  by  spherical  or  cylindrical  sur- 
faces by  transmission  or  reflection. 

Irregular  refraction  is  that  which  occurs  by  accident  or  design  such  as 
may  occur  in  broken  glass  in  the  alley  or  in  the  diamond  faceted  by  expert 
workmen. 

I  have  purposely  given  in  the  diagram  subdivision  to  sixteenths;  but 
have  only  made  fifteen  paragraphs  covering  Optics  and  its  fourteen  sub- 
divisions. The  other  sixteen  words  in  the  last  column  are  merely  for  sug- 
gestions in  defining  the  ones  covered  in  the  paragraphs. 

It  is  worthy  of  mention  that  the  fourteen  subdivisions  of  the  subject 
"optics"  are  as  many  as  the  elements  known  to  be  necessary  in  the  composi- 
tion of  the  human  body. 

f  Fundamental....  ..  /  Physics 

Theory 

(  Technical....  ..  /  Mathematics 

\  Physiology 

Ophthalmology 

(  Symptomatology /  Objective 

Practice Subjective 

Analysis....  -  /  Dynamic 

\  Static 

Ophthalmology,   considered  properly,   comprises   not  merely  the   study 


INTRODUCTION  11 


of  the  eyes  and  their  appendages:  it  includes  the  nervous  and  circulatory 
systems,  the  digestive  and  egestive  apparatus,  and  all  of  the  body  functions, 
with  especial  reference  to  the  manner  in  which  nerve  strain  through  the  eyes 
affects  general  physiology  and  how  reflexes  from  such  affections  return  to 
the  eyes. 

Theories  are  worthless  unless  they  are  founded  on  sound  principles. 
Many  of  the  errors  of  the  old-school  practitioners  are  easily  traceable  to  wild 
ideas  in  which  the  wish  is  father  to  the  thought  expressed. 

Fundamental  means  a  leading,  or  primary  principle,  which  serves  as 
the  ground-work  of  a  system. 

Physics  is  the  science  of  Nature  and  covers  the  study  of  material  things. 
After  which  we  may  be  able  to  form  rational  ideas  of  subjects  which  are 
confined  to  the  realm  of  speculation.  Ages  ago  Aristotle  coined  the  word 
"metaphysics,"  which  means  "after  physics."  He  was  the  great  agnostic 
of  his  time,  a  true  philosopher  (lover  of  truth),  hence  not  at  all  popular 
with  the  bosses  who  found  it  to  their  advantage  to  keep  the  general  public 
ignorant. 

Anatomy  is  the  physical  study  of  the  body,  its  composition  and  arrange- 
ment. The  manner  in  which  it  is  taught  in  the  old  schools  yields  compara- 
tively little  information  and  their  students  with  whom  we  have  come  in  con- 
tact were  lamentably  deficient  in  practical  knowledge. 

Technical  means,  literally,  "to  bring  forth ;"  therefore  it  becomes  a 
necessity  in  the  study  of  any  subject  to  go  into  great  detail;  yet  excessive 
technicality  may  be  confusing  to  the  student  and  good  teachers  avoid  it. 

Mathematics,  as  expressed  in  simple  arithmetic,  affords  abundant  facili- 
ties for  instruction  in  all  business  and  professional  work,  and  the  most  suc- 
cessful men  and  women  in  all  lines  have  limited  themselves  to  it,  excepting 
departures  for  special  purposes  or  for  entertainment. 

Physiology  is  the  reason  for  anatomy,  expressed  in  one  word.  In  my 
school  we  teach  anatomy,  physiology,  pathology  and  therapy  all  at  once.  It 
interests  and  instructs  students,  and  they  do  not  forget.  Our  work  is  so  in- 
tensely attractive  that  neither  teachers  nor  pupils  are  ever  late  in  assembling. 

Practice  is  the  putting  into  action  the  knowledge  acquired  by  study, 
and  those  who  have  learned  the  principles  of  their  profession  thoroughly 
cannot  fail  to  be  enthusiastic,  successful  practitioners. 

Symptomatology  as  taught  by  us  is  as  different  from  that  of  the  old 
schools  as  could  be  imagined.  Briefly,  we  teach  what  constitute  symptoms 
of  normality  and  that  any  departure  therefrom  indicates  a  necessity  for 
prompt  and  vigorous  action ;  our  proposition  is  based  on  fundamental  facts. 
Others  teach  an  alleged  symptomatology  which  is  purely  empirical  and, 
while  rational,  within  narrow  limits,  is  often  positively  wrong,  hence  mis- 
leading. 

Objective  symptomatology  is  that  which  is  exposed  to  us  macroscopical- 
ly  and  microscopically.  The  ophthalmoscope,  combined  with  the  dioptric 
system  of  the  eye,  becomes  a  wonderful  microscope. 

Subjective  symptomatology  is  that  which  is  developed  by  questioning 
patients  and  considering  such  information  in  connection  with  what  we  know 
from  our  training  and  experience. 


A  SYSTEM  OF  MATURK  MEDICINE 


Analysis  of  a  case  involves  the  consideration  of  the  details  of  an  ex- 
amination, separately  and  as  a  whole;  it  enables  us  to  proceed  with  cer- 
tainty in  practice,  while  "diagnosis"  means  working  by  guess,  which  is,  to 
say  the  least,  very  uncertain. 

Dynamic  means  force.  Any  test  which  requires  a  patient  to  exhibit  his 
physiological  powers  is  dynamic  and  we  have  some  very  practical  yet  ab- 
solutely harmless  ones.  The  Neurometer  is  based  on  these. 

Static  means  natural.  We  have  such  tests,  which  we  employ  to  sub- 
stantiate or  refute  the  dynamic  showings.  They  are  a  part  of  the  Neuro- 
meter, which  is  not  a  machine,  as  many  have  supposed,  but  is  a  series  of 
tables  which  we  employ  in  making  analyses  of  cases. 

For  general  study  we  have  the  following  as  a  fundamental  proposition  : 

f  Inorganic  .....................  j  Water 


f  Chemistry !  ]  Salts 

(  Organic {  Fats 

Mathematics <(  (  Carbohydrates 

f  ,Form....  -  I  Regular 

}  Irregular 


Mechanics. 


Motion 5  Systematic 


Locomotor 

Mathematics   suggests   accuracy,   consecutiveness,   thoroughness,   law. 
Chemistry  relates  to  the  composition  of  matter  and  the  changes  it  un- 
dergoes. 

Inorganic  chemistry  is  the  science  which  treats  of  elements  and  their 
properties.  Water,  salts,  air  and  light. 

Organic  chemistry  is  the  study  of  the  composition  of  the  structures  of 
plants  and  animals.  Fats  and  carbohydrates  chiefly. 

Mechanics  treats  of  the  action  of  forces,  statically  and  dynamically; 
light,  gases,  liquids  and  solids. 

Form  covers  a  division  of  mechanics  relating  to  architecture,  and  an- 
atomy. A  form  may  be  regular  or  irregular. 

Motion  is  physiological  mechanics  with  the  duality :  systemic  and  loco- 
motor. 

If  any  subject  be  skeletonized  in  this  manner  it  conduces  to  satisfactory 
analysis  and  ready  understanding. 

In  the  preparation  of  copy  for  this  work  I  have  received  much!  valuable 
assistance  from  my  colleague  in  school  work,  William  L.  Black,  M.  D.,  which 
assistance  is  hereby  acknowledged  with  gratitude. 

THE  AUTHOR. 
Chicago,  July  17,  1916. 


N.  B. — Some  of  the  results  of  calculations  are  expressed  in  mixed  num- 
bers and  some  in  decimals  for  the  purpose  of  instructing  students  in  arithmet- 
ical gymnastics.  Some  of  the  decimals  are  carried  out  farther  than  others, 
for  the  same  reason. §  The  chief  object  of  the  work  is  to  teach  principles. 
Common  fractions  are  absolute;  decimals  are  approximate. 


CHAPTER  I. 

Refraction  and  Reflection  by  Plane,  Parallel  Surfaces. 
Following  is  the  composition  of  four  kinds  of  glass: 

1.  Sodium'  Glass:  Window,  plate,  table  and  bottle  glass;  sometimes 
called  soda-glass,  or  soft  glass,  to  distinguish  it  from  potassium-calcium 
glass,  which  is  hard.  Formula: 

2Na,Cp,    +    2CaCOs    +    2SiO2    =    Na4SiO4    +     Ca2SiO4    +     tCO2 
Washing  Lime-  Sand  Sodium  Calcium  Carbon 

Soda  stone  Silicate  Silicate  Di-oxid 

The  CO,  bubbles  off  and  the  remaining  mixture  of  sodium  silicate  and 
calcium  silicate  solidifies  on  cooling. 

2.  Potassium-Calcium  Glass :    Bohemian   crown  or  hard  glass  is  used 
largely  for  chemical  glassware,  because  it  is  not  so  easily  attacked  by  many 
reagents  and  withstands  greater  heat  without  softening.     Formula: 

2K2CO3      +      2CaCOs      +      2SiO2      =      K.SiQ.      +      Ca.,SiO4      +      4CO2 
Potassium          Calcium  Silicon  Potassium        Calcium  Carbon 

Carbonate          Carbonate          Di-ox.  Silicate  Silicate  Di-ox. 

3.  Sodium-Lead  Glass :    A  mixture  of  lead  silicate  and  sodium  silicate. 
It  is  softer  and  melts  at  a  lower  temperature  than  plate  glass.     Flint  and  cut 
glass  come  under  this  head.     Formula: 

2PbO      +      Na2CO3      +      2SiO2      =      Pb2SiO4      +      Na4SiO4      +      2CO2 
Lead  Sodium  Silicon  Lead  Sodium  Carbon 

Oxide  Carbonate          Di-ox.  Silicate  Silicate  Di-ox. 

4.  Potassium-Lead  Glass :    A  mixture  of  potassium  and  lead  silicates. 
It  gives  a  variety  of  flint  and  cut  glass.    Formula : 

2PbO      +      2K,CO3      +      2SiO2      =      Pb2SiO4      +      K4SiO4      -f-      2CO2 
Lead  Potass.  Silicon  Lead  Potass.  Carbon 

Oxide  Carbonate         Di-ox.  Silicate  Silicate  Di-ox. 


Refraction  means  "to  break." 

Refraction  of  light  is  the  deviation  in  its  course  a  ray  suffers  in  passing, 
obliquely,  from  one  transparent  medium  into  another  of  different  optical 
density. 

Chemistry  and  Mechanics  constitute  the  duality  of  causative  factors 
which  result  in  refraction.  Chemistry  is  represented  in  the  composition  of 
the  material.  Mechanics,  in  the  form  of  the  mediums. 

An  Index  of  Refraction  is  the  expression  in  figures  of  the  Optical  Den- 


14  A  SYSTEM  OF  MATURE  MEDICINE 

sity  of  different  transparent  mediums  compared  with  an  agreed  standard. 
Air,  compared  with  a  vacuum,  has  the  index  1.000294;  but,  as  air  is  the 
most  common  and  rarest  of  all  practical  mediums,  it  was  selected  as  the 
standard  and  other  mediums  have  their  indexes  based  upon  it. 

Optical  Density  differs  from  mere  compactness  by  representing  the  rela- 
tive resistance  offered  to  the  passage  of  light  through  different  transparent 
mediums. 

Following  is  a  table  of  indexes  of  various  mediums : 

Hydrogen     ._ 1.000029    Flint  Glass 1.57    to  1.64 

Air    1.000294    Optical   Lens   Glass 1.523  to  1.64 

Oxygen   1.000272    Ice   1.31 

Nitrogen   1.0003        Rock   Crystal   1.562 

Carbonic  Acid  1.000439    Diamond    2.50    to  2.70 

Water    1.33J          Cornea  and  Aqueous 1.3365 

White  of  Egg 1.351          Vitreous  Humor  1.3365 

Human  Blood  : 1.354          Crystalline   Lens  1.4371 

Canada  Balsam 1.523  Same,      compared     with    '  sur- 

Sea   Salt   Solution 1.375  rounding    media    1.0752 

Crown   Glass  _ 1.50  Index  of  eye  as  a  whole 1.52198 

The  Index,  or  Optical  Density,  is,  inversely,  the  relative  rate  of  speed 
at  which  rays  travel  in  the  several  mediums ;  the  denser  the  medium  the 
slower  the  speed.  Thus,  the  rate  of  speed  at  which  light  travels  through  air 
is  186,000  miles  per  second ;  crown  glass,  with  an  index  of  1.50,  would  offer 
50  per  cent  more  resistance,  hence  the  rate  of  speed  in  the  glass  would  be 
only  two-thirds  of  that  in  air,  or,  124,000  miles  per  second. 

To  find  the  index  of  one  medium  compared  with  another  when  the  in- 
dexes of  the  two,  compared  with  a  standard,  are  known :  Divide  the  greater- 
figure  by  the  lesser,  because  this  keeps  the  rarer  medium  the  standard. 

Index  makes  possible  the  location  of  courses  of  sections  of  rays  before, 
during  and  after  the  passage  through  given  mediums,  by  enabling  measure- 
ments to  be  made  of  the  angles  formed  with  the  perpendiculars  to  the 
.respective  surfaces  at  the  points  where  refraction  occurs,  because  all  measure- 
ments are  predicated  upon  the  resistance  offered  by  the  denser  medium. 

Attraction  is  a  better  word  than  density  to  employ  when  the  deviation  of 
rays  is  being  considered. 

The  amount  of  refraction  is  regulated  by  the  angle  of  obliquity  at  which 
a  ray  approaches  the  surface  of  the  dense  medium  and  by  the  density  or 
chemical  attraction  thereof.  The  first  is  an  inconstant  and  the  second  is  a 
constant  with  respect  to  all  mediums. 

In  the  definition  of  refraction,  at  the  beginning  of  this  chapter,  the  word 
"obliquely"  is  of  particular  significance,  because,  if  a  ray  approaches  the 
second  medium  perpendicularly  to  the  surface,  that  is  at  right  angles,  it 
will  pass  through  without  change  in  its  course,  suffering  only  from  reflection 
and  absorption.  The  reason  for  reflection  is  that  the  amount  of  light  ap- 
proaching is  much  greater  than  can  be  passed,  hence  the  surplus  is  repelled 
at  the  surface  of  the  dense  medium;  absorption  occurs  to  such  an  extent 
that  unless  the  light  is  very  strong  it  will  not  penetrate  even  air  any  great 
distance.  This  is  the  reason  a  light  from  a  lamp  cannot  be  seen  from  more 
than  a  mile  or  two  on  best  nights  for  the  test,  that  is  with  clear  atmosphere. 

The  reason  for  breaks  in  lines  representing  rays,  at  the  surfaces  of 
mediums,  is  that  being  of  different  optical  densities  they  have  different  at- 


REFRACTION  BY  PLANE  SURFACES 


tractive  powers,  so  that  a  ray  in  passing  obliquely  from  one  transparent 
medium  into  another  of  greater  density,  or  attractive  p^wer,  is  drawn  toward 
a  perpendicular  erected  to  the  surface  at  the  point  where  the  break  occurs, 
making  the  angle  formed  by  the  refracted  section  and  the  perpendicular  as 
much  smaller  than  that  formed  by  the  approaching  ray  and  the  same  perpen- 
dicular as  the  index  of  refraction  of  the  rare  medium  is  smaller  than  that  of 
the  dense  and,  on  leaving  the  dense  medium  for  the  rare,  the  action  is  reversed, 
because  the  attractive  force  of  the  dense  medium  is  withdrawn.  The  first 
deviation  is  positive  refraction  and  the  second  is  negative  refraction.  In  the 
latter  instance  the  angle  formed  by  the  emergent  section  and  the  perpen- 
dicular is  as  much  larger  than  the  angle  formed  by  the  ray  in  the  dense 
medium  with  the  same  perpendicular  as  the  index  of  the  dense  medium  is 
greater  than  that  of  the  rare. 

Students  should  note  the  entrance  of  Nature's  duality  system  at  the  be- 
ginning and  become  familiar  with  it,  because  it  will  be  found  conspicuous  in 
all  departments  of  this  and  other  studies.  We  shall  employ  it  frequently 
and  even  carry  it  to  the  extent  of  diagrams,  splitting  subjects  into  halves, 
quarters,  eighths,  and  sometimes  even  to  sixteenths  and  thirty-seconds.  It 
is  a  part  of  our  scheme  of  consecutiveness. 

Fig.  1  is  made  on  a  half-centimeter  scale. 
It  should  be  studied  carefully,  because  it 
illustrates  the  first  principles  of  the  laws  of 
refraction,  without  a  good  working  knowl- 
edge of  which  no  one  can  ever  hope  to  be- 
come a  competent  ophthalmologist.  It  is 
a  deplorable  fact  that  very  few  of  the  most 
pretentious  oculists  and  opticians  know  any- 
thing whatever  about  these  fundamentals. 
They  often  proclaim  themselves  by  de-. 
nouncing  others  as  "quacks." 

The  lines  marked  R',  R2  and  R3  are,  re- 
spectively, the  incident,  refracted  and 
emergent  sections  of  a  ray  passing  from  air 
into  glass  then  into  air  again.  The  course 
of  the  incident  section  is  toward  C',  but, 
as  it  approaches  obliquely,  it  is  refracted  at 
the  first  surface  and  its  new  course  is  found 
by  measuring  the  angle  of  incidence  at  a 
convenient  point,  as  indicated  by  the  scale, 
and  marked  If  on  the  upper  horizontal  line; 
then,  continuing  it  across  the  vertical  line,  P',  to  PI',  and  marking  the  short 
end  1.  These  two  sections  of  the  horizontal  line  bear  the  same  relation  to 
each  other  that  the  indexes  of  the  two  mediums  do.  From  the  end  of  the 
line  1  the  vertical  line,  PI'  is  dropped,  parallel  with  P'.  Now  measuring  the 
distance  from  O,  on  the  incident  section,  to  the  point  of  refraction,  and  dupli- 
cating that  distance  obliquely  toward  the  line  PI',  it  will  locate  the  point 
where  the  refracted  section  will  cross,  thus  giving  its  course  to  the  other 
surface;  the  dotted  line  from  x'  marks  the  angle  of  refraction,  1.00,  which  is 


16 


A  SYSTEM  OF  MATURE  MEDICINE 


to  the  angle  of  incidence,  1.50,  as  the  index  of  the  rare  medium  is  to  that  of 
the  dense.  The  refracted  section,  R2,  strikes  the  second  surface  at  the  line 
P2  and  the  first  proceeding  is  reversed,  the  horizontal  line  from  R2,  crossing 
P2,  has  its  short  end,  1,  on  the  right,  and  its  long  end,  1£,  on  the  left  of  the 
line  P2.  Dropping  the  line  PI2  parallel  with  P2,  then  measuring  the  distance 
on  the  refracted  section  from  the  horizontal  line,  1,  to  the  point  of  refraction 
and  measuring  the  same  distance,  obliquely,  to  PI2  at  the  dotted  line,  x2, 
locates  the  point  where  the  emergent  section  will  cross  and  its  course,  R3, 
toward  C3,  parallel  with  the  original  course  of  the  incident  section.  The 
angle  of  emergence  is  to  the  angle  of  refraction  (the  angle  in  the  dense 
medium),  as  the  index  of  the  dense  medium  is  to  that  of  the  rare.  A  is  the 
angle  of  incidence ;  B  the  angle  of  refraction ;  E  the  angle  of  incidence  to 
the  second  surface,  also  known  as  the  angle  of  refraction,  because  that  is 
what  it  would  be  if  the  ray  approached  from  below;  F  is  the  angle  of 
emergence. 

In  refraction  by  plane,  parallel  surfaces,  the  angles  of  incidence  and 
emergence  are  always  of  equal  size ;  the  two  angles  in  the  dense  medium  are 
of  equal  size;  the  relation  between  the  lesser  and  the  greater  is  always 
that  of  the  index  of  the  rare  medium  compared  with  that  of  the  dense.  The 
angle  formed  by  the  reflected  sections  of  rays  with  the  perpendiculars  to  the 
surfaces  is  always  of  equal  size  with  its  angle  of  incidence,  no  matter  what 
the  index  of  refraction  may  be,  and  the  reflected  ray  always  passes  away  on 
the  opposite  side  of  the  perpendicular. 

The  method  of  making  measurements,  illustrated  in  Fig.  1,  I  have 
named  the  Perpendicular-Parallel  method. 

After  establishing  the  fact  that  in  refraction  by  plane,  parallel  surfaces, 
the  emergent  section  always  parallels  the  course  of  the  incident  section, 
the  last  half  of  the  method  might  be  omitted  and  the  course  finished  arbi- 
trarily ;  but  then  there  would  be  no  proof  that  the  first  part  of  the  drawing  is 

correct ;  while  if,  by  measure- 
ments, the  emergent  section 
takes  the  course  we  know  it 
should,  the  work  is  proved. 
Particular  attention  is  called  to 
this  point  because  no  method 
of  practicing  anything  is  cor- 
rect until  the  practitioner 
knows  four  cardinal  principles : 

First,  what  he  wants  to  do.. 
Second,  why  he  wants  to  do  it. 
Third,  how  to  do  it. 
Fourth,  how  to  prove  it. 

Fig.  2,  \  cm.  scale,  shows 
another  way  to  construct  Fig. 
1.  In  this,  after  measuring  the 
angle  of  incidence  at  A'  and 
dropping  the  parallel,  PI',  the 
point  of  refraction  is  taken  as 


REFRACTION  BY  PLANE  SURFACES 


r 


the  center  of  a  circle  from  P'  through  the  incident  section  at  A',  where  the 
angle  is  measured,  to  B',  which  locates  the  point  where  the  refracted  section 
will  cross  PI'.  Then  after  erecting  P2,  measuring  the  angle  at  A2  and  drop- 
ping the  parallel  PI2,  the  point  of  second  refraction  is  taken  as  the  center 
of  another  circle  from  P2  past  A2  to  B2  and  the  point  where  it  strikes  the 
line  PI2  is  the  course  of  the  emergent  section,  R3.  This  may  be  used  in- 
dependent of  the  parallels  to  perpendiculars,  by  merely  measuring  the  angles 
of  incidence  to  each  surface  and  making  the  circles  of  indicated  radii,  then 
measuring  on  the  circles  as  indicated  by  the  dotted  lines  at  B'  and  B2  to 
get  the  angles  of  refraction  and  emergence  respectively.  I  have  combined 
the  methods  here  to  show  how  one  proves  the  other.  Fig.  2  illustrates  the 
Circle  method,  as  well  as  the  Perpendicular  Parallel  one. 

Fig.  3,  1  cm.  scale,  shows  a 
very  simple  way  to  find  the  course 
of  the  refracted  section,  etc.  I 
call  it  the  Chord-Arc  method. 
After  erecting  the  perpendicular, 
P',  at  the  point  where  the  incident 
ray  strikes  the  first  surface,  and 
measuring  the  angle  of  incidence 
at  a  convenient  place,  C' ',  take  the 
point  of  refraction  as  the  center  of 
a  circle  of  which  A'  is  the  arc ; 
then  divide  that  half  of  the  chord 
marked  C',  which  measures  the 
angle  of  incidence,  so  that  when 
measured  from  the  perpendicular 
toward  R'  the  longer  portion  will 
be  to  the  full  length  of  the  line 
C'  what  the  index  of  the  rare 
medium  is  to  the  dense;  erect  a 
perpendicular  to  strike  the  arc  at 
A' ;  then  draw  the  line  represent- 
ing the  refracted  section  as  if  it 
came  from  A',  proceeding  in  the 
At  the  second  surface  erect  the  perpendicular  P2,  measure 


direction  A2, 
the  angle  C2 


from  P2  to  A3,  the  full  length  of  the  line  between  P2  and  A3 
being  to  that  portion  between  P2  and  R2  what  the  index  of  the  dense  medium 
is  to  that  of  the  rare;  then,  taking  the  point  of  refraction  as  the  center  of  a 
circle  of  which  the  curved  line  from  Rfl2  to  A3  is  the  arc,  and  drop  the  short 
vertical  line  at  A3  from  the  line  C2  to  the  arc  to  get  the  point  from  which  the 
emergent  section  R3  appears  to  be  directed. 

A  portion  of  each  ray  is  lost  by  reflection  at  each  refracting  surface,  (Rfl' 
and  Rfl2,  Fig.  3),  the  angles  formed  with  the  perpendiculars  by  the  reflected 
sections  being  exactly  the  same  size  as  the  angles  of  incidence  and  always  on 
the  opposite  sides  of  the  perpendiculars,  regardless  of  the  difference  in  in- 
dexes of  refraction  of  different  mediums.  The  amount  lost  by  reflection 
increases  with  increase  in  the  size  of  angle  of  incidence  until,  when  the 


18 


A  SYSTEM  OF  MATURE  MEDICINE 


latter  is  about  50  degrees,  there  is  total  reflection  so  far  as  optical  purpose 
is  concerned.    This  is  called  the  limit  angle. 

The  indexes  of  glass  used  for  optical  pur- 
poses are  various  and  nearly  all  are  expressed 
in  figures  which  do  not  work  well  in  making 
drawings  such  as  Figs.  1,  2,  3.  It  would  be 
difficult  to  measure  1.53  and  other  smaller 
divisions  than  halves,  quarters,  etc.,  so  neces- 
sity spurred  me  to  devise  easy  methods.  One 
is  presented  in  Fig.  4,  and  I  have  named  it  the 
Base-Line  method. 

R1,  R2  and  R3  are,  respectively,  the  incident, 
refracted  and  emergent  sections  of  the  ray. 
The  line  BL'  is  the  base-line  for  finding  the 
course  of  the  refracted  section.  It  is  placed 
on  the  right  and  below  R'  because  we  know 
the  break  on  entering  the  denser  medium  will  be  toward  the  perpendicular 
X'.  This  line,  from  the  point  of  refraction  to  O'  is  10  mm.  long;  and  this 
distance  backward  on  the  base-line  toward  the  first  surface,  marked  O2,  is 
the  point  to  measure  from  after  a  calculation. 

Rule:     The  perpendicular,   X',  multiplied  by  the  index,   1.50,  and  the 
product  divided  by  the  excess  index,  .50,  will  give  the  distance  from  O2  to 
F',  the  point  toward  which  the  refracted  section  will  be  directed. 
10x1.50  =  15-f-  .50  =  30  mm.  from  O2  to  F'. 

The  line  BL2  is  the  base-line  for  finding  the  course  of  the  emergent 
section.  It  is  placed  on  the  right  and*above  R'  because  we  know  the  break  on 
leaving  the  denser  medium  will  be  from  the  perpendicular  X2.  The  line,  from 
the  point  of  refraction  to  O3,  is  8  mm.  long;  atid  this  distance  forward  on 
the  base-line  toward  the  second  refracting  surface,  marked  O4,  is  the  point 


to  measure  from  after  another  calculation. 

Rule :  The  perpendicular,  X2,  divided  by 
the  excess  index,  .50,  gives  the  distance  from 
O4  to  F2,  the  point  on  the  base-line  toward 
which  the  emergent  section  will  be  directed. 

8-f-  .50  =  16  mm.  from  O4  to  F2. 

It  is  one  of  the  principles  of  refraction 
that  the  reduction  in  size  of  angle,  on  en- 
tering a  dense  medium  from  a  rarer  one, 
is  less  than  the  gain  on  leaving  that  medium. 
With  an  index  of  1.50  the  loss  on  entering  is 
one-third  and  the  gain  on  leaving  is  one-half. 
From  these  facts  the  rules  given  were  made. 
Fig.  5  shows  another  simple  method  of 
finding  the  courses  of  the  refracted  and 
emergent  sections.  R',  R2  and  R3  are  the 
incident,  refracted  and  emergent  sections  of 
the  ray.  P  is  the  perpendicular  to  the  sur- 
face at  the  point  of  first  refraction. 


REFRACTION  BY  PLANE  SURFACES 


19 


.  Rule:  The  distance  from  1  to  2,  multiplied  by  the  index,  gives  the  dis- 
tance from  1  to  3,  from  which  point  the  refracted  section  takes  its  course. 
The  distance  from  3  to  4,  divided  by  the  index,  gives  the  distance  from  4 
to  5,  from  which  point  the  emergent  section  takes  its  course. 

I  have  named  this  the  Single  Perpendicular  method.  It  and  the  Base- 
Line  method  work  equally  well  with  any  index  of  refraction. 

Fig.  6  is  given  to  illustrate  the  necessity  for  figuring  new  indexes  when 
there  are  several  mediums,  or  when  air  is  not  one  of  the  mediums  used.  The 
Single  Perpendicular  method  is  employed  to  illustrate  its  simplicity.  First 
the  comparison  of  indexes  is  made  and  recorded :  Air  is  to  water  as  3  is 
to  4 ;  water  is  to  glass  as  8  is  to  9 ;  glass  is  to  diamond  as  3  is  to  5 ;  diamond 
is  to  air  as  2£  is  to  1. 

R1,  R2,  R3,  R4,  R5,  are  the  several  sections  of  the  ray.  The  distance  from 
1,  on  the  perpendicular  to  2,  where  the  incident  section  crosses,  multiplied 
by  the  index  of  water,  1.33^,  gives  the  distance  from  1  to  3,  from  which 

point  the  refracted  section 
takes  its  course  in  the 
water;  the  distance  from 
3  to  4,  multiplied  by  the 
index  of  glass  compared 
with  water  (9  is  to  8  as 
1.125  is  to  1.00),  gives  the 
"distance  from  4  to  5,  from 
which  point  the  refracted 
section  takes  its  course 
in  the  glass;  the  distance 
from  5  to  6,  multiplied  by 
the  index  of  diamond  com- 
pared with  glass  (5  is  to 
3  as  1.66$  is  to  1.00), 
gives  the  distance  from  6 
to  7,  from  which  point  the 
refracted  section  in  the 
diamond  takes  its  course; 
the  distance  from  7  to  8, 
divided  by  the  index  of 
diamond,  2.50,  gives  the 
distance  from  8  to  9,  from 
which  point  the  emergent 
section  takes  its  course. 

The  principles  exhibited 
by  plane,  parallel  surface 
refraction  hold  good  all 
the  way  through  the 
work ;  but,  as  we  proceed, 
we  shall  find  new  ones 
added,  which,  at  a  glance, 
may  appear  to  supersede  these.  This  is  not  true,  however,  as  will  be  shown. 


/// 

i      — 

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4f               $                 /.  33^-^6 

//v 

9                             1 

/'if 

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20 


A  SYSTEM  OF  MATURE  MEDICINE 


Physical  principles  extend  far  beyond  purely  physical  matters.  They 
work  physiologically  and  metaphysically.  They  are  the  base  of  true  theory 
and  practice. 

In  this  chapter  we  have  been  introduced  to  Infinity  and  discover  at  once 
that  It  is  something  greater  than  any  possible  conception  of  a  personal 
"creator"  or  "ruler,"  such  as  has  been  pictured  in  alleged  "holy"  books  writ- 
ten by  professedly  "inspired"  people  of  a  mythical  age. 

Note  the  law  of  constants  and  inconstants  as  exemplified  in  the  constancy 
of  the  density  of  Natural  mediums  and  the  inconstancy  of  artificial  ones ; 
also  in  the  changeable  angles  of  incidence  and  the  constancy  of  their  relations 
to  other  angles. 

The  limit  angle  teaches  there  is  not  only  a  limit  to  the  effectiveness  of 
all  laws,,,  but  a  limit  to  our  capacities  of  comprehension,  endurance,  etc.  As 
the  limit  angles  are  different  for  different  mediums,  so  are  the  capacities  of 
different  people  unlike. 

As  refraction  is  accompanied  by  reflection,  dispersion  and  absorption,  so 
is  learning  associated  with  losses,  distortions  and  misunderstandings;  hence 
we  must  have  means  of  proving  conclusions. 

In  the  illustrations  we  have  the  dualities :  two  indexes,  two  perpen- 
diculars, two  parallels,  two.  base-lines,  two  refracting  surfaces,  etc.  Then 
there  are  double  dualities :  the  four  sections  of  a  ray,  the  four  angles  with 
the  perpendiculars,  the  four  effects,  reflection,  refraction,  dispersion,  absorp- 
tion. 


We  originated  and  are  the  sole  teachers  of  the  method  of  straightening 
cross-eyes  without  operation,  thus  avoiding  the  possibilities  of  death  from 
cocaine  poisoning.  We  prove  operation  is  not  needed,  hence  is  a  dangerous 
proposition  in  many  ways. 


CHAPTER  H. 

Refraction  and  Reflection  by  Plane  Surfaces,  Forming  Prisms. 
As  a  physical  proposition  prisms  present  many  important  features.     As 
a  physiological  one  it  is  most  important  to  know  why  they  should  not  be 
employed  therapeutically.     The  latter  phase  of  this  subject  will  be  attended 
to  in  detail  in  another  chapter. 

The  laws  employed  in  illustrating  refraction  and  reflection  by  plane, 
parallel  surfaces  apply  equally  well  to  plane  surfaces  inclined  toward  each 
other,  forming  prisms ;  but  the  final  result,  exhibited  by  the  emergent  ray, 
is  different,  because  of  the  change  in  shape  of  the  denser  medium.  The  sur- 
faces not  being  parallel  the  perpendiculars  cannot  be,  hence  the  course  of 
an  emergent  section  is  not  parallel  with  that  of  the  incident  section,  but  is 
always  toward  the  base  line  of  the  prism. 

Fig.  7  shows  a  prism,  or  transparent  wedge. 
Other  illustrations  will  show  the  angle  of  construction, 
or  the  angle  formed  by  the  two  sides  and  the  base, 
as  may  be  seen  in  the  two  ends  of  this  figure.  They 
will  also  show  the  angle  of  deviation,  which  is  the 
amount  of  change  in  the  course  of  a  ray  passing  a 
prism.  Also  other  features  of  prisms  will  be  shown, 
all  of  which  are  of  great  importance  to  the  student. 

To  be  convinced  quickly  of  the  deceptive  quali- 
ties of  prisms  the  student  needs  only  to  look  at  the 
drawing  steadily,  holding  a  finger  at  the  upper  left 
corner,  when  he  will  note  the  prism  apparently   re- 
**/'  verses  ends  so  that  the  finger  will  be  seen  first  on  one 

side  of  the  figure,  then  on  the  other.  Next,  lay  the  book  on  a  table,  sit  at 
arm's  length  and  rotate  it,  keeping  the  eyes  fixed  obliquely  downward  on  the 
prism  and  watch  its  antics. 

These  optical  illusions  are  the  complementary  exhibits  associated 
with  all  vision,  which  will  be  considered  further  in  the  physiological  portion 
of  this  work. 

Fig.  8  illustrates  several  points:  First,  that  portion  showing  above  the 
base  line,  B  L,  is  the  prism,  its  angle  of  construction  shown  by  the  two 
sides  and  the  base  line  connecting  them  ;  second,  the  apex  is  the  center  of 
the  part  of  a  circle  which  cuts  the  base  line  to  include  the  base  of  the  prism 
as  the  chord  of  the  circle,  the  arc  showing  just  below;  third,  the  portion  of 
the  drawing  below  the  base  line  forms  an  air  angle,  which,  measured  on 


22 


A  SYSTEM  OF  MATURE  MEDICINE 


the  vertical  midline,  is  to  the  whole  line  as  the  index  of  air  is  to  that  of  the 
dense  medium,  1.00  to  1.50  in  this  instance.  This  gives  at  y  the  length  of  the 
base  of  the  angle  of  deviation  by  the  first  surface,  and  at  x  the  base  of  the 
angle  of  deviation  by  the  prism. 

The  drawing  is  made  by  the  Perpendicular  Parallel  method,  R'  being  the 
incident  section  of  a  ray,  which  is  broken  at  the  first  surface  toward  the 
point  F'  on  line  PI'  as  if  it  came  from  R2 ;  and  at  the  second  surface  it  is 
broken  toward  F2,  on  the  base  line,  as  if  it  came  from  R3,  which,  with  R' 
forms  the  angle  of  deviation,  D,  measured  at  a  point  as  far  from  the  meet- 
ing point  of  those  two  rays,  O,  as  the  prism  is  high  on  its  mid-line.  D 
corresponds  to  X  on  the  air  angle,  or  to  the  base  of  the  prism,  (the  arc, 
strictly)  multiplied  by  the  excess  index  of  the  dense  medium,  .50.  The  line 


4 


P'    is   the   perpendicular   to 
allel ;  P2  is  the  perpendicular 
parallel.    The  measurements 
manner  as    in    Fig.    1.     The 
with  the   base   line   and  one 
troduce      the      system      of 
mon    use.      The     unit    is    a 
angle    that    a    ray    entering 
and  one  centimeter  from  it 
100  centimeters  (1  meter)  dis- 
base  line  8  cm.  from  the  dot 
of  refraction,  hence,  8  divided 
If  the  incident  ray  is  at  a  great- 
than  1  cm.  the  units  found  by 
by  the  distance  the  incident  ray 
of  value.    Thus,  if  the  incident 
timeter  from  the  base  line  and 
after    refraction,    it    would    be 
and  one-half  centimeters  from 
point  on  the  base  line  after  re- 
times as  strong. 

The  angle  of  reflection  at 
the  same   as    the    angle   of  in- 


the  first  surface  and  PI'  is  its  par- 
to  the  second  surface  and  PI2  is  its 
of  the  angles  are  made  in  the  same 
incident     ray     approaches     parallel 
centimeter  from   it.     This  is  to  in- 
numbering  prisms  which  is  in  corn- 
prism    of    such    a    deviating 
f*?'         parallel  with    the    base  line 
will  be  broken  to  meet  the  base  line 
tant.  This  figure  breaks  the  ray  to  the 
,    on  the  base  line  marking  the  plane 
into  100,  gives  12.5  units  of  power. 
er  or  less  distance  from  the  base  line 
the  above  process  must  be  multiplied 
is  from  the  base  line  to  get  the  units 
ray  in  this  figure  was  only  half  a  cen- 
had  the  same  point  on  the  base  line 
only  half  as  strong;  but  if  it  was  one 
the  base  line  and  still  had  the  same 
fraction,  it  would  be  one  and  one-half 

each   surface   of  the   prism   would   be 
cidence   to   each    surface,   and   on   the 


REFRACTION  BY  PRISMS 


23 


opposite  side  of  the  perpendiculars.     They  are  not  shown  in  the  drawing 
because  they  ought  to  be  understood  on  account  of  their  constancy. 


-/Pi 


Fig.  9  shows  the 
base  line  of  the 
'allel  with  it;  other 
this  instance  a  line 
face  to  the  point  C' 
long,  and,  with  index 


Base-Line  method  as  applied  to  prisms.  The 
prism  is  utilized  when  the  incident  ray  is  par- 
wise  special  base  lines  must  be  supplied.  In 
(dashed)  from  where  R'  strikes  the  first  sur- 
would  correspond  to  x'  Fig.  4.  It  is  50  mm. 
1.50: 

50X1-50  =  75-=-  .50  =  150  mm.  from  the  plane  of  refraction  to  F'  on  the 
Base-Line1,  would  be  the  direction  of  the 'refracted  section  of  the  ray,  as^  if 
it  came  from  R2  toward  F'.  Base-Line2  is  drawn  parallel  with  the  refracted 
section  and  the  distance  (dashed)  from  C2  on  that  line  to  the  point  where 
the  second  break  occurs,  corresponds  to  x2  Fig.  4,  hence,  38-h-  .50  =  76  mm. 
from  the  dot  on  the  base-line  below  the  prism  to  the  point  F2,  toward  which 
the  emergent  section  will  be  directed.  As  in  Fig.  8,  x,  on  the  form  below, 
equals  D  the  base  of  the  angle  of  deviation. 

The  angle  of  construction  of  a  prism  and  the  angle  of  deviation  formed 
by  it  are  in  the  same  ratio  that  air  bears  to  the  excess  index  of  the  denser 
medium,  hence  the  rule : 

To  find  the  angle  of  construction  for  any  required  angle  of  deviation. 
Divide  the  angle  of  deviation  by  the  excess  index  of  the  dense  medium.  Or,  if 
the  angle  of  construction  is  known,  in  degrees,  minutes  and  seconds,  or  any 
base  line  measure,  to  find  the  angle  of  deviation,  multiply  by  the  excess  index 
of  the  dense  medium. 

This  rule  is  exact  so  long  as  the  prism  is  weak  enough  so  that  if  a  cir- 
cle be  drawn  with  the  prism  apex  for  its  center,  its  sides  the  radii  and  its  base 
the  chord,  the  arc  can  scarcely  be  distinguished  from  the  chord.  See  Fig.  8. 

In  Figs.  8  and  9  the  portions  below  the  base  lines  of  the  prisms  are  to 
the  entire  figure  as  1.00  is  to  1.50  and  it  will  be  noted  that  the  apexes  of  the 
angles  of  deviation  are  at  points  distance  from  the  first  surfaces  toward 
the  second  in  exactly  the  same  ratio,  or  two-thirds  of  the  thickness  of  the 
prisms  on  the  line  of  incidence.  Were  the  index  1.52  the  apexes  of  the  angles 
of  deviation  would  be  10</]-,:>  of  the  distance  across  the  prisms  on  the  lines  of 
incidence. 

The  total  length  of  the  lines  bisecting  Figs.  8  and  9  represent  in  units 


A  SYSTEM  OF  MATURE  MEDICINE 


the  indexes  of  refraction  of  the  dense  mediums.  The  portions  above  the 
base  lines  represent  the  excess  index  of  the  dense  mediums  over  the  rare.  The 
portions  below  the  base  lines  represent  the  standard  index  of  air,  1.00.  In 
these  instances,  the  index  being  1.50,  the  lines  are  150  points  long  and  the 
base  lines  cut  them  50  points  from  the  tops,  leaving  100  below ;  had  the 
index  been  1.52  there  would  be  52  points  above  to  100  below.  Then  the  lines 
at  the  lower  ends  of  the  figures,  measured  at  x,  a  distance  from  the  lower 
points  equal  to  the  height  of  the  prisms,  are  always  the  measures  of  the 
angles  of  deviation,  their  apexes  being  at  points  in  the  prisms,  found  in  the 
manner  described  in  the  preceding  paragraph. 


Fig.  10  shows  a  prism  6  mm.  thick  on  the  line  of  incidence,  1  1,  same 
as  in  Fig.  9.  As  the  index  is  1.00  outside  and  1.50  inside,  the  location  of 
the  apex  of  the  angle  of  deviation  will  be  4  mm.  from  the  first  surface,  be- 
cause 4  is  to  6  as  1.00  is  to  1.50.  Measuring  from  that  point  backward  on 
the  line  of  incidence  a  distance  equal  to  the  height  of  the  prism  we  erect  the 
vertical  line  A  which  is  the  base  of  the  angle  of  deviation  because  the  base- 
line of  the  prism,  10  mm.,  multiplied  by  the  excess  index,  .50,  gives  5,  the 
length  of  the  line  at  A.  Or,  we  get  the  same  thing  from  the  line  x  in  Fig. 
9.  Then,  running  the  line  3  3,  from  the  line  A  through  the  point  located 
in  the  prism,  we  have  the  emergent  course  to  F.  All  we  have  to  do  to  show 
the  refracted  section  is  to  draw  a  line  connecting  the  incident  and  emergent 
sections,  as  shown  by  the  line  2  2  as  it  passes  from  surface  to  surface  of 
the  prism. 

I  have  added  here  the  line  P,  which  is  perpendicular  to  the  first  surface 
and  measures  52  mm.  Applying  the  rule,  we  have :  , 

52x1.50  =  78-^-  .50  =  156  mm.  as  the  distance  on  the  base  line,  measured 
from  the  plane  of  refraction  along  the  line  2  2  to  a  point  toward  which  the 
refracted  ray  will  be  directed  while  passing  the  prism.  Then  at  the  second 
surface  I  have  another  Base-Line  and  a  perpendicular,  P2,  which  measures 
19  mm.,  which  divided  by  .50,  gives  38  mm.  to  the  point  x  on  Base-Line'-' 
measured  from  the  dot  on  that  line  in  the  prism.  This  gives  the  final  course 
of  the  ray  to  F  and  enables  us  to  prove  the  other  method  worked  correctly. 
The  position  of  the  dot  is  found  as  in  Fig.  4. 

It  is  a  coincidence  worthy  of  mention  that  rays  approaching  parallel 
with  the  base  line  of  a  prism  of  two  equal  sides  and  an  index  of  1.50  will 
emerge  parallel  with  the  perpendicular  to  the  point  of  contact  with  the  first 
surface. 

Rays  approaching  a  prism  parallel  will  all  strike  it  at  like  angles  and 
will  be  refracted  the  same,  passing  away  parallel ;  but  if  they  approach  at 
different  angles  the  effects  will  be  different. 


REFRACTION  BY  PRISMS 


Fig.  11  shows  rays  starting  from  O  as  1,  2,  3,  and  the  same  lines  after 
refraction  by  the  prism ;  1  and  2  pass  away  as  if  they  came  from  the  point 

A,  while  2  and  3  appear  to  come  from  point  B.     The  amount  of  refraction 
is  the  same  for  each  ray,  as  is  shown  by  the  dotted  lines  marking  the  angles 
of  deviation,  but  the  effects  are  different  as  is  exhibited  in  the  points  A  and 

B.  This    we    will    call    angle   aberration    or    maximum,    intermediate    and 
minimum  refraction.     Any  ray  from  O,  striking  the  surface  above  the  line 
2  will  be  refracted  so  that  it  will  meet  line  2  in  the  general  direction  B,  a  little 
farther  away  than  a  plane  erected  at  O ;  and  any  ray  striking  tlje  prism  below 
line  2  will  be  refracted  so  that  it  will  meet  line  2  in  the  general  direction  A, 
a  little  nearer  than  a  plane  at  O.     Thus  it  can  be  seen  that  minimum  re- 
fraction  occurs   in   any   given    instance   on   the   ray   that  passes   the   prism 
exactly  parallel  with  the  base  line,  as  2  in  this  instance,  and  maximum  re- 
fraction occurs  on  rays  which  pass  above  or  below  that  ray,  which  we  will 
call  the  dominant  ray. 

In  Chapter  I  reference  was  made  to  the  dispersion  of  light  into  its 
elementary  colors.  This  applies  particularly  to  Natural  light,  which  is  sunlight, 
and  that  developed  artificially,  as  the  calcium  light  and  the  electric  arc 
light  which  approach  very  nearly  the  composition  of  sunlight. 

In  the  early  days  of  modern  optical  study,  something  over  a  hundred 
years  ago,  when  microscopy  was  in  its  infancy,  it  was  found,  when  lenses 
were  made  of  such  curves  that  they  magnified  objects  as  much  as  twenty 
diameters,  400  times,  the  virtual  object,  as  seen  through  the  lens,  was 
indistinct  and  somewhat  colored.  It  was  soon  found  that  the  chemical 
composition  of  the  lens  had  some  part  in  this  disturbance  and  that  the  curves 
of  the  surface  did  the  rest.  These  were  denominated  chromatic  aberration, 
because  of  the  colors,  and  spherical  aberration,  because  of  the  forms  of  the 
lenses.  The  latter  will  be  explained  elsewhere  in  this  book. 

Experiments  developed  the  fact  that  differences  in  the  composition  of 
the  glass  used  caused  great  variations  in  the  amount  of  dispersion,  but  com- 
paratively little  in  the  refracting 
properties. 

Fig.  12  shows  dispersion  by 
a  prism  of  "crown"  glass,  the 
seven  parallel  incident  lines 
representing  a  ray  of  white  light 
and  their  continuations  through 
the  prism  show  the  different  re- 
fractive effects  on  the  several  ele- 
mentary colors  which  result  in 
the  development  of  the  spec- 
trum, comprising  red,  orange, 


A  SYSTEM  OF  MATURE  MEDICINE 


yellow,  green, 'blue,  indigo,  violet.  Another  prism,  made  from  "flint"  glass, 
having  practically  the  same  index  of  refraction,  would  have  nearly  twice  as 
much  dispersive  power;  hence  a  "flint"  prism  with  an  angle  of  construction 
half  as  great  as  the  "crown,"  Fig.  12,  would  have  as  much  dispersive  power, 
thus  proving  that  it  is  the  chemical  attraction  of  glass  which  dominates  in 
the  duality  regulating  the  amount  of  refraction,  instead  of  what  is  ordinarily 
expressed  as  "the  angle  of  incidence  and  the  optical  density  of  the  dense 
medium." 


Fig.  13  shows  how  the  two  prisms  may  be  combined  to  eliminate 
dispersion,  yet  secure  any  amount  of  refraction  desired :  Simply  combine  two 
prisms,  one  of  "crown"  and  the  other  of  "flint"  glass,  the  latter  constructed 
one-half  as  large  as  the  other,  when  the  double  dispersive  power  of  the  "flint" 
will  neutralize  the  dispersion  of  the  "crown,"  while  the  refraction  of  the 
"crown,"  being  twice  that  of  the  "flint,"  on  account  of  its  angle  of  construc- 
tion, will  still  render  half  of  its  original  power. 

Application  of  the  principle  to  lenses  will  be  explained  in  the  chapters  on 
that  subject.  They  will  be  understood  better  there. 


Fig.  14,  |  cm.  scale,  shows  two  combinations  of  prisms  having,  respect- 
ively, positive  (-)-)  and  negative  ( — )  effects  on  rays  passed  through  them. 
The  two  combinations  are  made  in  one  drawing  to  show  how  the  figures  for 
one  may  be  used  for  the  other.  The  base  line  of  the  -+-  is  the  apex  line  of  the 
other,  except  that  in  the  --  the  apexes  lap  each  other;  if  made  absolutely 


REFRACTION  BY  PRISMS 


apex  to  apex  there  would  be  nothing  at  the  mid-line.  This  will  show  why  - 
lenses  are  a  little  heavier  than  -j-  of  the  same  power.  What  has  been  called 
the  base  line. of  prisms  will  hereafter  be  called  the  axial  line,  because  there 
will  always  be  something  on  both  sides  of  it.  The  ray  R,  connecting  the 
two  combinations,  parallels  the  axis  and  the  line  P,  perpendicular  to  the 
first  surface  of  the  -j-  prism,  will  be  used  to  find  the  courses  of  the  rays 
through  both  combinations.  After  finding  the  course  of  the  refracted  ray 
in  the  -f-  prism  by  the  Perpendicular  Parallel  method,  shown  by  the  line 
2  2,  the  line  3  3,  drawn  parallel  with  it,  through  the  —  combination,  gives  the 
course  of  the  refracted  ray  in  that  instance.  Then,  drawing  the  emergent 
ray,  R',  'from  the  second  surface  of  the  -f-  prism,  parallel  with  the  perpen- 
dicular to  the  first  surface,  to  the  point  F',  and  drawing  the  emergent  ray, 
R2,  from  the  -  -  prism,  parallel  with  R'  as  if  it  came  from  the  point  F2. 
we  have  the  figure  complete,  showing  a  positive  focus  at  F'  by  the  -J-  com- 
bination, and  a  negative  focus  at  F2  by  the  —  combination. 


Fig.  15  illustrates  further  the  effect  of  prisms  with  bases  together  and 
reversed.  Parallel  rays,  marked  x,  which  approach  at  equal  distances  from 
the  axial  line,  are  refracted  toward  points  by  the  -f-  combination,  while  from 
the  —  combination  they  pass  away  after  refraction  as  if  they  came  from  the 
points  indicated  by  the  dashed  lines.  On  the  left  we  have  the  positive  focal 
points  of  the  -f-  and  on  the  right  of  them  are  the  negative  focal  points  of  the 
-  combinations,  and  we  have  the  reasons  for  each.  (Fig.  15  is  not  made  to 
measure.) 


Fig.  16  shows,  at  the  left,  a  curved  surface  at  a  little  distance  from 
the  prism  surfaces.  The  meeting  point,  C',  of  the  perpendiculars,  P',  to  the 
surfaces  of  the  prisms,  is  used  as  the  center  of  curvature  of  the  curved  sur- 
face to  illustrate  that  at  the  points  where  the  lines  pass  the  curve  they  are 
perpendicular  to  both  surface*,  and  at  no  other  points  would  a  perpendicular 


A  SYSTEM  OF  MATURE  MEDICINE 


to  either  surface  be  perpendicular  to  the  other;  hence,  those  points  are  the 
only  ones  where  those  prisms  are  represented  in  the  curved  line.  On  the 
right  the  curved  surface  is  drawn  so  the  prism  surfaces  are  -tangents,  to 
show  that  pafallel  rays,  striking  the  points  where  the  perpendiculars  P2  are 
erected,  would,  with  an  index  of  1.50,  be  refracted  to  the  point  indicated  by 
the  dashed  lines,  because  the  distance  from  the  points  of  refraction  to  C2 
(51  mm.)  multiplied  by  1.50  and  divided  by  .50  gives  63  mm.  As  the  rest 
of  the  prism  surface  is  cut  away  and  other  angles,  really  multitudes  of  prisms, 
substituted  automatically  in  grinding  the  curved  surface,  the  result  is  a 
common  focus  of  all  the  parallel  rays  at  that  point,  with  an  exception  which 
will  be  explained  in  the  next  chapter. 


This   woman's   eyes   were   straightened    instantly   by   our   operationless 
methods. 


CHAPTER  III. 

Refraction  and  Reflection  By  Single  Curved  Surfaces. 

All  principles  of  laws  are  constant;  but  the  manner  in  which  they  are 
employed  may  seem  to  modify  them;  and,  to  some  extent,  this  is  actually 
true.  It  is  all  the  more  necessary  to  study  them  closely. 

As  was  shown  at  the  end  of  Chapter  II,  curved  surfaces  are  equivalent 
to  a  multitude  of  prisms.  To  erect  perpendiculars  to  plane  surfaces  a  square 
must  be  used;  and  even  then  it  is  difficult  to  be  exact;  but  all  spherical 
curves  have  centers  from  which  all  radial  lines  are  perpendiculars  to  the 
prisms  forming-  the  surfaces  pierced  by  them. 

The  propositions  offered  by  single  curved  surfaces  are: 

1.  Rays  approaching  them  parallel  with  the  course  of  any  radial  line,  or 
divergent  from  any  such   line  and  starting  from  a  point  farther  from   the 
surface  than  the  principal  focal  distance  of  the   curved   surface   presented, 
will  be  brought  to  a  focus  by  refraction,  if  the  curve  be  positive,  and  by 
reflection  if  the  curve  be  negative.     There  will  also  be  a  negative  focus,  by 
reflection,  in  the  first  instance,  and  by  refraction  in  the  second. 

2.  The  center  of  curvature  establishes  a  starting  point  for  all  perpen- 
diculars to  the  surface.    It  is  the  optical  center  and  nodal  points,  because  all 
rays  directed  toward  it  pass  the  surface  perpendicularly,  hence  without  re- 
fraction. 

3.  The  radius  of  curvature  and  the  index  of  refraction  constitute  the 
basis  on  which  the  refracting  power  is  figured. 

4.  Single  curved  surfaces  have  first  and  second  principal  focal  distances 
by  refraction;  the  second  being  in  the  same  ratio  to  the  first  that  the  index 
of  refraction  of  the  dense  medium  bears  to  that  of  the  rare.     With  reference 
to  the  index,  the  radius,  and  the  principal  focal  distances  we  have  the  fol- 
lowing : 

1.  The  radius,  divided  by  the  excess  index  of  the  dense  medium  gives 
the  first  principal  focal   distance,  in  the  rare  medium. 

Formula:    R-=-ExI=F' 

2.  The  radius,  multiplied  by  the  index  of  the  dense  medium  and  divided 
by  the  excess  index,  gives  the  second  principal  focal  distance,  in  the  dense 
medium. 

Formula:     R  x  I  -f-  ExI  =  F2 

3.  Adding  the  radius  to  the  first  principal  focal  distance  gives  the  sec- 
ond principal  focal  distance;  or,  subtracting  the  radius  from  the  second  will 
give  the  first. 

Formula:     F'  +  R  =  F2.     Or,  F2  —  R  =  F' 


A  SYSTEM  OF  MATURE  MEDICINE 


4.  The  radius,   divided  by  the  first  principal  focal  distance,  gives  the 
excess  index  of  the  denser  medium. 

Formula:      R  -f-  F'  =  ExI. 

5.  The  first  principal   focal  distance,   multiplied   by  the   excess   index, 
gives  the  radius. 

Formula:     F'  x  ExI  =z  R. 

6.  The   second  principal   focal  distance,   divided  by  the   first   principal 
focal  distance,  gives  the  index. 

Formula:     F2  -j-  F'  =  I. 

7.  The   first   principal   focal    distance,    multiplied    by   the   index,   gives 
the  second  principal  focal  distance. 

Formula:     F'  x  I  =  F*. 

Or,  the  second  principal  focal  distance,  divided  by  the  index,  gives  the 
first  principal  focal  distance. 

Formula:     F2  -r- 1  —  F'. 

8.  The  second  principal  focal  distance,  multiplied  by  the  excess  index 
and  divided  by  the  index,  gives  the  radius  of  curvature. 

Formula :     F2  x  ExI  -=-  I  =  R. 

With  reference  to  conjugate  focal  distances,  that  is,  points  where  objects 
and  their  images  are  located  outside  of  the  principal  focal  distances,  we  have : 

1.  Any  distance  farther  from  the  surface  than  the  principal  focal  dis- 
tance, on  either  side,  multiplied  by  the  principal  focal  distance  on  the  op- 
posite side  and  divided  by  the  difference  between  itself  and  the  principal 
focal  distance  on  the  near  side,  will  give  the  conjugate  focal  distance  on  the 
opposite  side. 

Formula :     Cf  x  OPf  +  (Cf '  —  NPf )  =  Cf2. 

Or,  the  two  principal  focal  distances  multiplied  together  and  divided  by 
the  difference  between  the  given  conjugate  focal  distance  and  the  principal 
focal  distance  on  the  near  side,  will  give  an  amount  which,  added  to  the 
principal  focal  distance  on  the  opposite  side,  will  be  the  second  conjugate 
focal  distance. 

Formula:     (F'  x  F2)  •*•  (Cf  —  NRf)  +  OPf  =  Cf2.    • 

2.  The  first  conjugate  focal  distance,  multiplied  by  the  index  and  by 
the  radius,  and  the  product  divided  by  a  figure  obtained  by  multiplying  the 
first  conjugate  focal  distance  by  the  excess  index  and  subtracting  the  radius, 
will  give  the  second  conjugate  focal  distance. 

(Cf'xI)xR 

Formula:      ,  ^,, — „    ,, =-— =  Cf . 

(Cf  x  ExI)  —  R 

3.  The  second  conjugate  focal  distance,  multiplied  by  the  radius  and 
the  product  divided  by  a  figure  obtained  by  multiplying  the  second  conjugate 
focal  distance  by  the  excess  index  and  subtracting  another  figure  secured 
by  multiplying  the  index  by  the  radius,  will  give  the  first  conjugate  focal 
distance. 

-  CPxR 

formula:         „  t —         -^ — =—-  =  Cf  . 

(Grx  ExI)  —  (I  x  R) 

4.  The  first  and  second  conjugate  focal  distances  multiplied  together, 
the  product  multiplied  by  the  excess  index,  and  the  result  divided  by  a  figure 
obtained  by  multiplying  the  first  conjugate  focal  distance  by  the  index  and 
adding  the  second  conjugate  focal  distance,  will  give  the  radius. 

^  (Cf  x  Cf2)  x  ExI 

Formula:      (CfxI)+Cf      =  R 


REFRACTION  BY  SINGLE  CV:RVED  SURFACES  31 

5.  Express   both   conjugate   focal   distances   in   diopters ;   multiply   the 
second  by  the  index;  add  the  first,  to  get  the  total  power;  convert  to  prin- 
cipal focal  distance  and  multiply  by  the  excess  index  to  get  the  radius. 

Formula:     (Cf2D  x  T)  -(-  Cf'D  —  Total  dioptric  power. 

(100  -f-  D  power)=  F'  x  ExI  =  R. 
The  reason  for  multiplying  the  second  conjugate  focal  power  by  the 

index  is  that  in  calculating  in  diopters  the  comparative  weakness  of  the 
focusing  power  in  the  dense  medium  must  be  allowed  for. 

6.  Having  both  conjugate  focal  distances  and  the  radius  of  curvature, 
to  find  the  index  of  refraction,  the  first  conjugate  focal  distance,  plus  the 
radius,  multiplied  by  the  second  conjugate  focal  distance  will  give  a  figure 
to  be  divided  by  another,  found  by  subtracting  the  radius  from  the  second 
conjugate  focal  distance  and  multiplying  the  product  by  the  first  conjugate 

focal  distance. 

_  (Cf +  R)xCf2 

Formula:   _______=  i. 

7.  Having  the  principal   focal  distances  and  the.  first  conjugate  focal 
distance,  in  the  rare  medium,  to  calculate  the  second  conjugate  focal  distance 
by  the  dioptric  method:    First  express  the  given  distances  in  diopters  and 
take  the  difference  between  fliem ;  second,  as  the  power  of  the  curve  on  rays 
entering  the  denser  medium  is  to  that  on  leaving  it  as  the  index  of  the  rare 
medium  is  to  that  of  the  dense,  divide  the  remaining  dioptric  power  by  the 
index  of  the  denser  medium  to    get    the    actual    effect  on  entering  it;  the 
product,  transposed  to  focal  distance,  will  locate  the  second  conjugate  focal 
point. 

Formula:     (F'D  —  Cf'D)  =  Cf'D  -4- 1  (transposed)  =  Cf2. 
If  the   first   conjugate   focal   point   is   in   the  denser   medium,   the   first 

conjugate  focal  distance,  expressed  in  diopters,  must  be  multiplied  by  the 
index  of  refraction  of  the  denser  medium,  because  the  power  is  increased 
on  leaving  it ;  then  the  product  is  deducted  from  the  principal  focal  power 
expressed  in  diopters,  and  the  remainder,  converted  to  focal  distance,  will  be 
the  second  conjugate  focal  distance.  In  other  words,  reversing  the  calcula- 
tion made  above  we  have  the  second  conjugate  focal  distance,  in  the  dense 
medium,  and  want  to  find  the  first. 

Formula:     F'D—  (Cf2D  x  I)  =  Cf'D. 

8.  The  principal  focus,  by  refraction,  is  an  inconstant,  being  regulated 

by  the  index  of  refraction  and  the  radius  of  curvature.  The  principal  focus  by 
reflection,  is  a  constant,  being  always  at  one  half  of  the  radial  distance  of 
the  surface  presented,  no  matter  what  the  index  of  the  medium  is,  or  whether 
it  be  glass  or  other  polished  substance.  Rays  form  principal  focuses  only 
when  they  approach  a  curved  surface  parallel  with  the  course  of  a  radial 
line  passing  from  the  center  of  curvature  through  the  apex  of  that  curvature. 
It  is  known  as  the  axial  line. 

In  Fig.  17,  millimeter  scale,  we  have  a  radius  of  20  millimeters.  To 
locate,  by  calculation,  the  first  principal  focal  point,  to  which  the  ray  R' 
will  be  directed,  we  have  the  law :  Radius,  divided  by  excess  index  gives 
first  principal  focal  distance ;  thus : 

20-=-  .50  =  40,  the  first  principal  focal  distance. 

The  points  are  also  found  by  the  perpendicular-parallel  method  and  the  an- 
gles are  marked  1  and  H.  R',  parallel  with  the  axial  line,  in  the  dense 


A  SYSTEM  OF  MATURE  MEDICINE 


medium,  forms  angle  1  with  the  perpendicular  P'  in  the  dense  medium,  and 
refraction  causes  the  angle  1£,  with  the  same  perpendicular,  in  the  rare 
medium,  the  refracted  section  going  to  F'.  Note  the  dashed  line,  O',  to 
the  point  x;  it  is  positive  reflection  of  a  portion  of  R'. 

To  locate,  by  calculation,  the  second  principal  focal  point,  to  which  ray 
R2  will  be  directed,  we  have  the  law :  Radius,  multiplied  by  index  and  divided 
by  excess  index,  gives  second  principal  focal  distance ;  thus, 

(20xl.50)-H  .50  =  60.  the  second  principal  focal  distance. 
By  the  perpendicular-parallel  method  R2,  parallel  with  the  axial  line  in  the 
rare  medium,  forms  angle  H  with  the  perpendicular,  P2,  in  the  rare  medium, 
and  refraction  causes  the  angle  1,  with  the  same  perpendicular,  in  the  dense 
medium,  the  refracted  section  going  to  F2.  Note  the  dashed  line,  O2,  from 
the  surface ;  it  is  the  negative  reflection  of  a  portion  of  R2  and  leaves  the 
surface  as  if  it  came  from  x  where  the  reflected  portion  of  R'  actually  went. 

The  reason  for  the  two  principal  focal  distances  will  be  understood  readily 
when  it  is  observed  that  the  angle  formed  by  R',  as  it  approaches  the  surface 
in  the  dense  medium,  is  increased  fifty  per  cent,  as  it  leaves  that  medium ; 
while  the  angle  formed  by  R2,  as  it  approaches  the  surface  in  the  rare  medium, 
is  reduced  only  one-third  as  it  enters  the  dense  medium.  The  relation  be- 
tween these  two  focal  distances  is  always  in  the  same  ratio  as  are  the  in- 
dexes of  the  two  mediums.  As  we  have  measured  from  the  refracting  sur- 
face the  long  focal  distance  is  shown  in  the  dense  medium.  If  we  had 
measured  from  the  optical  center,  C,  the  short  focus  would  be  in  the  dense 
medium.  When  we  come  to  lenses  the  measurements  will  be  from  the  surface 
in  some  instances,  from  the  optical  center  and  from  nodal  points  in  others. 

•      I  l.ffO 


Fig.  18  shows  how  parallel  rays,  R  R,  entering  the  denser  medium, 
are  brought  to  a  common  point  at  the  second  principal  focal  distance  of  the 
curvature,  which  has  a  radius  of  30  millimeters  hence, 


REFRACTION  BY  SINGLE  CURVED  SURFACES 


(30xl.50)-f-  .50  =  90,  the  second  principal  focal  distance.  If  the  rays 
were  parallel  in  the  denser  medium  they  would  be  focused  outside  at  60 
millimeters,  because, 

30-^  .50  =  60,  the  first  principal  focal  distance. 

The  point  on  the  axial  line  where  the  curved  surface  crosses  it  is  the 
principal  point  and  a  vertical  line,  at  right  angles  with  the  axial  line  at  this 
point  is  the  principal  plane  of  a  surface. 


Fig.  19  shows  how  parallel  rays,  R  R,  in  the  denser  medium,  pass  away 
after  refraction  as  if  they  came  from  F.  With  the  same  radius  as  Fig.  18 
the  short  focus  is  now  found  inside,  measuring  from  the  surface ;  this  is  be- 
cause of  the  law,  as  explained  by  Fig.  17,  that  the  greatest  effects  are  upon 
rays  leaving  the  dense  medium.  If  the  rays  were  parallel  in  the  rare  medium 
they  would  be  refracted  on  entering  the  dense  and  pass  away  from  the  sur- 
face as  if  they  came  from  a  point  90  mm.  from  the  surface.  This  is  negative 
refraction,  based  on  the  comparative  breaks  toward  and  from  the  axis. 

In  the  first  sentence  of  this  and  at  the  close  of  the  preceding  chapter, 
reference  was  made  to  modifications  of  the  lawrs.  We  have  an  instance  of 
that  here :  Figs.  18  and  19  are  not  absolutely  true.  The  law,  as  given  for 
refraction  by  plane  surfaces,  is  as  sure  as  ever  for  single  rays ;  but,  it  will 
be  remembered,  a  limit  angle  was  mentioned,  where  all  laws  cease  to  apply, 
and  the  point  where  total  reflection  occurs  was  cited  as  an  example. 


In  Fig.  20,  millimeter  scale,  we  have  another  exhibit.  Students  will  re- 
call the  injunction  that  the  amount  of  refraction  is  regulated  by  the  density 
(chemical  attraction)  of  the  medium  and  the  angle  of  incidence.  The  density 
is  constant  in  a  given  medium,  but  the  angles  of  incidence  differ;  hence,  while 


A  SYSTEM  OF  MATURE  MEDICINE 


the  angles  of  incidence  and  of  refraction  bear  the  same  relation  to  each  other, 
with  reference  to  R'  and  R3,  being  1^  to  1  each,  the  rays  R'  and  R2  focus 
at  F',  while  those  from  R3  and  R'1  focus  at  F2.  So  rays  between  R'  and  R4 
and  between  R2  and  R3  would  focus  at  different  distances  between  F'  and 
F2,  and  rays  nearer  the  axis  than  R'  and  R2  would  focus  beyond  F'.  Thus 
we  discover  that  spherical  aberration  prevents  the  possibility  of  any  such 
perfect  focus  as  shown  by  Figs.  18  and  19.  Concave  lenses  have  the  same 
faults,  negatively,  as  Fig.  19  is  the  reverse  of  Fig.  18. 

Inasmuch  as  the  central  spaces  of  curved  surfaces  are  utilized  chiefly, 
and  as  the  law  of  calculation  fits  the  point  F',~  supported  by  lenses,  under 
practical  tests,  by  giving  the  best  pictures  at  such  points,  we  have  a  pretty 
illustration  of  how  Nature  supplies  theoretical  means  of  learning  the  best 
practical  applications  of  laws. 

Fig.  20  has  a  radius  of  30  millimeters;  the  index  is  1.50;  hence: 

30x1.50  =  45-f-  .50  =  90,  the  second  principal  focal  distance,  F'. 

This  is  corroborated  by  the  perpendicular-parallel  method  on  the  ray 
R'.  But  the  same  method  applied  to  R3  shows  F2  at  76  millimeters,  because 
the  angles  at  which  rays  R3  and  R4  strike  the  surface  are  much  greater  than 
the  others.  The  effect  of  the  aberration,  as  shown,  is  to  make  all  spherically 
curved  surfaces  astigmatic,  that  is  without  a  common  focal  point,  because 
the  rays  which  cross  the  axis  at  many  points  from  F2  to  F'  and  beyond,  pass 
away  divergent  and  form  circles  of  diffusion  or  spots  of  light  instead  of 
focuses.  It  should  be  borne  in  mind  that  the  drawing  only  shows  a  sectional 
view  and  that  the  entire  front  of  a  spherical  surface  would  give  many  rays 
from  every  point  around  the  axis,  so  that  the  lines  in  the  drawing,  before 
and  after  crossing  the  axis,  represent  the  diameters  of  circles  which  combine 
to  produce  what  has  been  termed  a  caustic.  This  is  most  pronounced  in 
curves  of  long  radius,  because,  when  the  radius  is  very  short,  the  distance 
between  F2  and  F'  is  so  short  as  to  be  scarcely  noticeable,  except  in  high 
power  instruments.  When  a  lens  has  such  curves  that  it  focuses  at  about 
two  inches  the  caustic  is  so  small  that  the  focus  is  nearly  enough  perfect 
that  it  may  be  used  for  a  burning-lens. 


Principal  focuses  are  fixed,  or  constant;  always  the  same  for  any  given 
index  and  curve ;  because  they  are  always  products  of  rays  which  were 
parallel  before  refraction.  Conjugate  focuses  are  inconstant,  or  shifty.  Fig. 
21,  millimeter  scale  shows  the  first  and  second  principal  focuses  of  a  -}- 
curved  surface,  as  found  by  calculation  according  to  the  rules  given,  namely ; 
the  radius  divided  by  the  excess  index  of  the  dense  medium  gives  the  first 
principal  focal  distance  and  adding  the  radius  gives  the  second  principal 


REFRACTION  BY  SINGLE  CURVED  SURFACES 


35 


local  distance.    The  negative  focus  of  the  reflected  portion  of  R2,  shown  as 
the  line  x,  is  indicated  by  the  point  NF. 


Fig.  22,  millimeter  scale,  shows  the  principal  focal  distance,  by  reflection, 
and  the  two  principal  focal  distances,  by  refraction,  of  a  —  surface.  The  ray 
R2  is  reflected  to  the  point  PF,  one-half  the  radial  distance  from  the  sur- 
face. This  is  the  positive  focal  distance.  The  same  ray  is  refracted  and  goes 
toward  x2  as  if  it  came  from  F2.  This  is  a  negative  focal  distance.  The  ray 
R'  is  refracted  toward  x'  as  if  it  came  from  F'.  This  is  also  a  negative  focal 
distance.  Note  that  the  reflected  portion  of  R'  goes  away  as  if  it  came 
from  PF,  making  that  point  the  negative  focus  of  that  portion  by  reflection 
while  it  is  the  positive  focus  of  R2  by  reflection.  Also  note  that  the  long 
focal  distance  is  on  the  outside  and  the  short  one  on  the  inside  of  the  dense 
medium;  just  the  reverse  of  Fig.  21. 

Rays  approaching  divergent  from  the  axis  and  from  a  point  farther  away 
than  the  principal  focal  distance,  will  be  rendered  convergent  by  refraction 
through  a  -|-  surface  and  will  meet  the  axis  at  a  point  which  can  always  be 
located  by  calculation  according  to  the  rule:  The  given  conjugate  focal 
distance,  multiplied  by  the  opposite  principal  focal  distance,  and  divided  by 
the  difference  between  the  given  conjugate  focal  distance  and  the  principal 
focal  distance  on  the  near  side,  will  give  the  other  conjugate  focal  distance. 


Conjugate  means,  literally,  "yoked  together" ;  hence,  points  which  send 
rays  to  and  receive  them  from  each  other,  by  refraction  or  reflection,  are  in 
conjugate  focus.  In  Fig.  23,  mm.  scale,  CF'  is  40  points  distant  from  the 
surface ;  F2  is  30  points  from  the  surface ;  the  difference  between  CF'  and 
F'  is  20  points ;  therefore,  applying  the  rule : 

40x30  =  1200-1-20  =  60,   the   second    conjugate   focal   distance,    CF2. 

To  prove  it  work  it  backwards.  CF2  is  60  points ;  F'  is  20  points ;  the 
difference  between  CF2  and  F2  is  30  points,  hence : 

60x20  =  1200-f-30  =  40,  the  opposite  conjugate  focal  distance,  CF'. 

To  calculate  the  second  conjugate  focal  distance  by  the  dioptric  method, 
the  first  principal  focal  distance  being  20  cm.,  or  5.00  diopters  and  the  first 
conjugate  focal  distance  being  40  cm.,  or  2.50  diopters,  we  deduct  it  from  the 
5.00,  leaving  2.50 ;  then,  as  the  power  of  the  curve  on  entering  the  denser 
medium  is  to  that  on  leaving  it  as  the  index  of  air  is  to  that  of  the  denser 


A  SYSTEM  OF  MATURE  MEDICINE 


medium,  we  divide  the  2.50  by  the  index  1.50  which  gives  the  dioptric  power 
on  entering  as  1.66f  or  a  second  conjugate  focal  distance  of  GO  cm.  Going 
the  other  way,  60  is  the  first  conjugate  focal  distance,  or  1.66§  diopters,  which 
must  be  multiplied  by  1.50,  the  index,  because  the  power  increases  outside ; 
this  multiplication  gives  2.50 ;  the  outside  principal  focus  being  20  cm.,  or 
5.00  diopters  we  deduct  our  2.50  from  it  leaving  2.50  or  the  40  cm.  outside 
conjugate  focal  distance. 

These  points  being  established,  we  know  that  rays  from  one  of  them 
will  diverge  from  the  axis  until  the  curved  surface  starts  convergence,  when 
they  will  meet  at  the  other,  no  matter  where  they  strike  the  surface.  This 
is  ignoring  the  aberration  feature,  because  it  is  not  sufficient  to  spoil  the 
image  formed,  as  will  be  shown. 


Another  way  to  locate  the  opposite  conjugate  focal  point  is  shown  in 
Fig.  24,  mm.  scale.  Let  CF'  be  the  first  conjugate  focal  point  and  F'  be 
the  first  principal  focal  point,  with  PI  as  its  plane.  Draw  the  line  R  of  D 
(ray  of  direction)  to  any  point  on  the  curve ;  then  start  the  guide  line  from 
the  point  on  the  line  PI  where  the  line  R  of  D  crosses,  and  extend  it  through 
the  center  of  curvature  at  C ;  then  continue  the  ray  parallel  with  the  guide 
line  until  it  strikes  the  axis.  This  works  no  matter  what  the  index  of  re- 
fraction may  be,  because  the  change  in  the  location  of  the  principal  focus 
to  suit  the  index  of  refraction  takes  care  of  such  differences. 


Fig.  25,  mm.  scale,  shows  a  —  curve  with  a  radius  of  20  points  ;  index, 
1.50;  negative  principal  focal  distances,  (50  and  40;  first  conjugate  focal  dis- 
tance, CF',  at  80  points.  To  find  the  second  conjugate  focal  distance  by 
reflection  from  the  concave  surface :  Multiply  the  first  conjugate  focal  dis- 
tance by  the  principal  focal  distance  and  divide  by  the  difference  between 
them.  The  principal  focal  distance  is  one-half  of  the  radius,  or  10  points; 
Hence: 

80x10  =  800-;-70  =  11.43,  the  second  conjugate  focal  distance. 

To  find  the  direction  of  the  refracted  portion  x2 :  Express  the  first 
conjugate  focal  distance  and  the  negative  focal  distance  on  the  same  side  of 
the  surface  in  units  based  on  a  standard  of  1,000  millimeters  to  the  unit ;  add 
them  and  divide  the  product  into  1,000  to  convert  back  into  distance.  Thus, 
with  a  radius  of  20  and  an  index  of  1.50  the  outside  negative  focal  distance 
is  60;  the  first  conjugate  focal  distance  is  given  as  80;  each  of  these,  divided 
into  1,000,  gives  16.66%  units  for  the  60  and  12.50  units  for  the  80;  the  12.50, 


REFRACTION  BY  SINGLE  CURVED  SURFACES 


divided  by  the  index,  1.50,  on  account  of  deficient  unit  power  in  single  curves, 
leaves  8.33%,  which,  added  to  16.66%,  gives  25.00  units,  which,  divided 
into  1,000,  gives  40  mm.  from  the  surface  to  the  point  x',  from  which  the 
•ray  x2  appears  to  proceed.  4Or  use: 

Formula:  (CF'xNPF)-f-(Cf'+OPF)  =  x'. 

The  negative  principal  focal  distance  on  the  outside  is  60 ;  the  con- 
jugate focal  distance  on  that  side  is  80,  therefore: 

80x60  =  4800-f- (80+ 40)    120  =  40,  or  x'. 


c' 


Fig.  26,  mm.  scale,  shows  the  manner  in  which  real  images  are  formed, 
inverted.  The  object  at  the  left  is  48  millimeters  from  the  principal  point, 
(apex  of  curvature)  of  a  curve  with  a  radius  of  12,  index  1.50,  hence  a  first 
principal  focal  distance  of  24  and  a  second  principal  focal  distance  of  36 
millimeters.  The  difference  between  the  object  distance  and  the  first  principal 
focal  distance  is  24 ;  hence : 

48x36  =  1728-4-24  =  72,  the  position  of  the  image  at  the  right. 

The  rays  from  B'  focus  at  B2,  according  to  the  law  as  illustrated  in 
Figs.  22  and  23.  For  the  same  reason  rays  from  A'  focus  at  A2  and  those 
from  C'  focus  at  C2,  because  the  lines  2  and  8  are  secondary  axial  rays 
crossing  the  principal  axis  at  the  optical  center,  while  other  rays,  from 
points  between  A'  and  C',  would  focus  at  corresponding  points  between  A2 
and  C2,  forming  a  complete  real  image,  inverted,  as  it  would  appear  on  a 
screen  if  tested  practically,  as  can  be  done  with  lenses. 

Note  that  the  object  is  at  twice  the  first  principal  focal  distance;  that 
the  relation  between  the  two  conjugate  focal  distances  from  the  surface  is 
the  same  as  that  between  the  two  indexes;  that  the  distances  of  object  and 
image  from  the  optical  center  are  equal;  that  object  and  image  are  of  equal 
size. 


Fig.  27,  mm.  scale,  shows  how  virtual  objects  are  formed,  erect,  by 
concave  surfaces.  O'  is  the  real  object,  80  mm.  from  the  surface,  which  has 
a  radius  of  20  mm.,  a  long  negative  focus  of  60  mm.  in  air  and  a  short  one 
of  40  mm.  in  the  glass.  The  divergent  rays.  2-2  from  the  axis  at  the  real 
object,  80  mm.,  represent  a  negative  power  of  12.50  units,  divided  by  1.50  on 


38  A  SYSTEM  OF  MATURE  MEDICINE 

account  of  the  unit  deficiency  of  the  single  curved  surface,  leaves  8. 331/3  units 
to  be  added  to  the  16.66%,  represented  by  the  negative  focal  distance  of  60 
mm.,  making  a  total  of  25.00  units,  with  a  negative  focal  point  of  40  mm., 
which  is  at  the  plane  O2. 

The  rays  3-3  and  4-4  are  refracted  and  pass  away  as  if  they  came  from 
the  points  on  the  real  object  from  which  they  actually  proceed.  The  rays 
1-1  pass  through  the  center  of  curvature,  C,  hence  the  course  is  straight 
back.  This  explains  why  objects  seen  through  concave  lenses  always  appear 
nearer  and  reduced  in  size.  The  sizes  of  image  and  object  are  as  the  distances 
from  C  to  each ;  in  this  instance,  as  20  is  to  60. 

Some  writers  have  compared  this  with  Fig.  26  to  show  that  "convex 
lenses  form  real  images,  inverted,  and  concave  lenses  form  virtual  images, 
erect."  This  is  a  false  statement.  First,  there  is  no  such  a  thing  as  a  virtual 
image;  second,  convex  lenses  form  real  images,  inverted,  by  refraction,  and 
concave  lenses  form  the  same  things,  by  reflection.  Both  are  positive  in  this 
respect.  Both  form  virtual  objects,  negatively,  by  refraction,  that  is  where 
the  objects  appear  to  be  when  viewed  through  the  lenses. 


Fig.  28,  mm.  scale,  shows  how  virtual  objects,  erect,  are  formed,  nega- 
tively, by  convex  surfaces.  The  real  object,  at  O  sends  rays  (the  black 
lines)  to  F2  along  lines  1,  1,  1,  1  and  to  2,  2  in  the  dense  medium  as  if  they 
came  from  O ;  also  the  clashed  lines  from  top  and  bottom  to  C.  Extending 
all  of  these  lines  backward  (dashed)  from  the  surface,  they  appear  to  come 
from  the  points  T  O2  B,  the  virtual  object.  This  explains  why  objects  seen 
through  convex  lenses  appear  more  distant  and  larger  than  they  really  are. 

In  this  connection  it  is  worthy  of  note  that  while,  as  a  rule,  convex 
surfaces  are  positive  and  concave  ones  are  negative  in  matters  of  refraction 
and  the  reverse  in  matters  of  reflection,  there  are  times  when,  figuring  on 
negative  propositions,  the  concave  is  radically  positive.  For  example,  the 
rule  for  figuring  the  position  of  the  virtual  object  for  any  concave  lens  is : 
Multiply  the  first  conjugate  focal  distance,  by  the  principal  focal  distance, 
(negative),  and  divide  the  product  by  the  sum  of  the  first  conjugate  focal 
distance  and  the  principal  (negative)  focal  distance.  The  same  rule  applies 
to  single  curved  concave  surfaces.  In  Fig.  27  the  first  conjugate  focal  dis- 
tance is  80  mm.,  the  principal  focal  distance  (negative)  is  60.  Multiplying 
them  together  and  dividing  as  per  formula,  page  37,  locates  the  virtual 
object  40  mm.  from  surface.  The  virtual  objects  seen  through  convex  sur- 
faces and  lenses  are  as  radically  negative.  Fig.  28  shows  a  convex  surface 
with  a  radius  of  20  mm.,  a  first  principal  focal  distance  of  40  mm.,  a  second 
principal  focal  distance  of  60  mm.,  and  a  real  object  20  mm.  from  the  surface. 
To  find  the  location  of  the  virtual  object:  Multiply  the  first  conjugate  focal 


REFLECTION  BY  MIRRORS 


distance  by  the  second  principal  focal  distance  and  divide  by  the  difference 
between  the  first  principal  focal  distance  and  the  object  distance.  Thus 
20x60  =  1200-K40— 20)  20  =  60,  the  position  of  the  virtual  object.  Or,  the 
first  principal  focal  distance,  expressed  in  units,  (diopters),  and  the  object 
distance  expressed  in  the  same  form,  the  first  subtracted  from  the  second, 
the  product  converted  to  millimeters  and  the  result  multiplied  by  the  index, 
will  give  the  same  result.  Thus,  the  first  principal  focal  distance,  40,  is 
25.00  units;  the  object  distance  20,  is  50.00  units:  the  difference  is  25.00  units, 
or  40  mm. ;  this,  multiplied  by  the  index,  1.50,  gives  60  as  the  virtual  object 
distance.  The  reason  for  this  proceeding  is  that  the  real  object  position,  20 
mm.,  is  calling  for  50.00  units  of  power  to  render  entering  rays  parallel  if 
they  were  to  pass  through  a  lens;  it  is  only  receiving  half  of  that  amount, 
hence  there  is  a  deficit  of  25.00  units ;  and,  as  it  is  a  single  curved  surface, 
only  two-thirds  of  that  amount  is  really  represented,  or  16.66%  units,  ren- 
dering a  negative  focus  of  60  mm. 


Fig.  29,  mm.  scale,  illustrates  the  formation  of  real  images,  inverted,  by 
reflection,  from  any  concave  polished  surface.  Let  A  represent  a  concave 
mirror  with  a  radius  of  40  mm.  with  the  object  "O"  at  100  mm.  The 
principal  focal  point,  being  midway  between  the  surface  and  the  center  of 
curvature,  is  20  mm. ;  hence  :  100x20  =  2,000^-  (100—20)  80  =  25,  the  second 
conjugate  focal  distance,  or  the  position  of  the  image,  I.  The  manner  in 
which  it  is  formed  is  that  the  rays  on  lines  x'  and  x2  are  reflected  straight 
back  upon  their  courses  and  meet  rays  represented  by  lines  1  and  2  respect- 
ively on  the  same  plane,  at  25,  while  other  rays  from  points  on  the  object 
between  top  and  bottom  form  the  rest  of  the  image.  The  angles  of  re- 
flection are  not  quite  equal  to  the  angles  of  incidence  in  this  instance  because 
the  point  at  which  reflection  occurs  is  at  such  a  distance  from-  the  axis  that 
spherical  aberration  is  exhibited.  The  drawing  was  made  by  calculation. 

Concave  spherical  mirrors  have  a  magnifying,  erect  effect  when  looked 
into  from  a  point  inside  the  principal  focal  distance,  and  an  inverted,  minify- 
ing effect  when  looked  into  from  a  point  outside  the  center  of  curvature. 
Convex  spherical  mirrors  have  a  minifying,  erect  effect  when  looked  into 
from  any  distance.  Cylindrical  mirrors,  concave  or  convex  have  similar 
effects  to  the  spherical  on  the  meridians  of  curvature  only.  Plane  mirrors 
reflect  without  magnifying  or  minifying. 

Fig.  30  shows  why  concave  mirrors  have  a  magnifying  effect  when  the 
object  is  inside  of  the  principal  focal  distance:  The- rays  1  from  the  top  and 
bottom  of  the  object  O  strike  the  surface  of  the  mirror  as  if  they  came  from 
the  center  of  curvature  C  and  are  reflected  back  along  the  same  lines  because 


40 


A  SYSTEM  OF  MATURE  MEDICINE 


they  are  perpendicular  to  the  surface;  rays  2  from  top  and  bottom  of  object 
approach  the  surface  of  the  mirror  parallel  with  the  axial  line,  hence  are 
reflected  toward  the  principal  focal  point  F  as  if  they  came  from  T  and  B 
at  which  points  they  meet  the  continuation  of  lines  1;  therefore  I  is  the 
magnified  image  of  O.  If  the  object  be  placed  outside  of  the  principal  focal 
distance  an  inverted  image  will  be  formed,  minified  if  object  is  outside  of  the 
center  of  curvature  and  magnified  if  object  is  between  the  center  of  curvature 
and  the  principal  focal  point  on  the  same  side  of  the  mirror. 


Fig.  31  shows  why  convex  mirrors  minify.  The  rays  1  from  top  and 
bottom  of  object  are  directed  toward  C,  the  center  of  curvature,  and  the 
rays  2,  from  the  same  points,  are  directed  toward  F,  the  negative  focal  point 
of  the  mirror,  hence  are  reflected  as  if  they  came  from  T  and  B  where  they 
meet  the  rays  1.  It  is  easy  to  see  that  the  farther  the  object  is  from  the 
surface  the  smaller  the  reflected  image. 


CHAPTER  IV. 

Refraction  and  Reflection  by  Piano-Convex  Lenses. 


Fig.  3.2,  $  mm.  scale,  shows  the  principal  focal  points,  optical  center  and 
nodal  points  of  a  plano-convex  lens. 

Rays  R2,  entering  from  the  plane  side,  parallel  with  the  axis,  only 
suffer  refraction  at  the  curved  surface,  hence  the  rule  for  finding  the  prin- 
cipal focal  distance  of  single  curved  surfaces  applies  without  change : 

Radius,  divided  by  excess  index,  equals  principal  focus,  F3. 

R',  entering  the  curved  surface  are  refracted  as  in  single  curved  sur- 
faces, hence : 

Radius,  multiplied  by  index  and  divided  by  excess  index,  equals  the 
second  principal  focal  distance,  F'.  But  the  refracted  rays  suffer  another 
break  at  the  second  surface  which  they  strike  obliquely.  To  find  the  final 
focal  distance: 

Divide  F'  by  the  index  of  refraction  to  locate  F2.    Or, 

Radius,  divided  by  excess  index,  equals  F2  or  F3. 

The  optical  center  and  one  nodal  point  are  at  the  apex  of  curvature  on 
the  axis,  because : 

Radius,  multiplied  by  lens  thickness  and  divided  by  sum  of  radii,  equals 
the  distance  from  plane  surface  to  optical  center. 

50x7*  =  _375_     =  7i       ints  from  flat  surface  to  O.    Or,  better : 
50  -f-  0  oO 

The  nodal  point  for  the  curved  surface  is  located  by  dividing  the  thick- 
ness of  the  lens  by  the  index  of  the  rare  medium,  1.00 : 

7iH-1.00  =  7£  points  from  flat  surface  to  N'  which  is  at  O. 


A  SYSTEM  OF  MATURE  MEDICINE 


The  nodal  point  for  the  flat  surface  is  located  by  dividing  the  thickness 
of  the  lens  by  the  index  of  the  dense  medium,  1.50: 

7£-=-l.oO  =  5  points  to  N. 


Plano-convex  lenses  have  one  flat  and  one  curved  surface.  They  are  not 
used  in  practice,  but  are  of  importance  theoretically,  because  they  embody 
optical  principles,  hence  the  story  would  be  incomplete  without  a  descrip- 
tion of  them. 

The  first  change  resulting  from  adding-  a  plane  second  surface  to  the 
single  curve  is  that  the  second  principal  focal  distance  is  eliminated,  be- 
cause rays  parallel  with  the  axis  entering  the  curved  surface  are  refracted 
toward  what  was  the  second  principal  focal  point  of  the  single  curved  sur- 
face and  strike  the  flat  surface  at  an  angle,  therefore  suffer  a  second  re- 
fraction, which  results  in  shortening  that  focal  distance  until  it  equals  the 
first  principal  focal  distance  of  the  single  curved  surface. 


Fig.  33,  1  mm.  scale,  shows  a  plano-convex  lens  as  the  segment  of  a 
globe,  the  dashed  line  indicates  the  circumference.  R',  approaching  parallel 
with  the  axis,  is  refracted  at  the  first  surface  and  passes  through  the  lens 
in  the  direction  F'  toward  a  point  90  mm.  from  the  surface  on  the  axis,  as 
if  it  came  from  x,  because  the  radius,  multiplied  by  the  index  and  divided 
by  the  excess  index  gives  that  figure.  At  the  second  surface  the  perpen- 
dicular, P,  a,  P,  is  drawn,  with  its  parallel,  PI,  fixed  by  measuring  the  angle 
of  incidence  to  the  second  surface,  measured  at  b,  1,  continued  1^  to  PL  The 
distance  from  b  to  a,  duplicated  from  a  to  c,  fixes  the  point  on  the  line  PI 
where  the  final  course  of  the  ray  will  cross  on  its  way  to  F2.  To  calculate 
this  distance  without  using  the  perpendicular-parallel  method :  Divide  the 
long  focal  distance  of  the  first  surface  by  the  index  of  refraction  of  the 
dense  medium.  This  is  particularly  valuable  if  the  index  is  1.523,  or  some 
other  fraction  than  1.50. 

R2,  entering  the  plane  side  parallel  with  the  axis  is  perpendicular  to 
the  flat  surface  and  passes  without  refraction ;  at  the  second  surface  it  is 
refracted  as  in  single  curved  surfaces,  so  that  the  effect  is  the  same  as  the 
two  refractions  give  to  the  ray  going  the  other  way. 


REFRACTION  BY  PLANO-CONVEX  LENSES 


Divide  the  radius  by  the  excess  index  of  the  dense  medium  to  get  the 
focal  distance,  for  parallel  rays  leaving  the  dense  medium. 

The  second  change  exhibited  by  the  lens  is  in  the  location  of  the  optical 
center,  which  is  the  crossing  point  of  secondary  axial  rays.  Fig.  34,  1  mm. 

scale,  shows  how  to  find  it.  The  axial 
line  P',  is  the  perpendicular  to  the  curved 
surface,  and  P2,  parallel  with  P',  is  a 
perpendicular  to  the  flat  surface.  The 
oblique  line,  passing  through  the  lens  and 
connecting  P2  with  P',  is  the  refracted 
section  of  a  secondary  axial  ray.  R', 
striking  the  surface  at  O,  going  in  the 
direction  x2,  is  refracted  as  if  it  came  from  a,  going  toward  b,  striking  the 
flat  surface  at  the  line  P2 ;  and,  being  refracted  again,  passes  to  R2  as  if 
it  came  from  x,  and  as  if  it  had  crossed  the  principal  axis  at  N. 

This  point,  N,  may  be  located  by  calculation :  Divide  the  thickness  of 
the  lens  by  the  index  of  the  dense  medium,  and  the  product  will  be  the 
distance  from  the  flat  surface  to  N  in  the  lens.  This  point  is  called  a  nodal 
point,  which  is  denned  as  the  point  on  the  principal  axis  where  secondary 
axial  rays  would  cross  if  they  were  not  refracted.  The  nodal  distance  from 
flat  surface,  multiplied  by  the  index  of  refraction,  locates  the  optical  cen- 
ter, O. 

Fig.  35,  1  mm.  scale,  shows  how  the 
nodal  point  may  be  found  by  the  Perpen- 
dicular-Parallel method :  The  ray  R'  ap- 
proaches the  surface  in  the  direction  x' 
and  striking  it  at  the  axial  line,  P',  is 
refracted  toward  b  as  if  it  came  from  a, 
and  at  the  second  surface  is  broken  again, 
passing  to  R2  as  if  it  came  from  x2,  and 
crossed  the  axial  line  at  N.  The  dis- 
tance from  1,  on  R',  to  O,  is  duplicated  in  the  distance  from  O  to  2,  on  PI', 
and  the  distance  from  3,  on  the  dashed  line  to  O2,  on  P2,  is  duplicated  by 
the  distance  from  O2  to  4,  on  PI2. 

It  has  been  shown  that 
the  angle  of  reflection 
equals  the  angle  of  inci- 
dence, no  matter  what  the 
index  of  refraction.  This 
law  plays  an  important 
part  sometimes,  as  is 
illustrated  in  Fig.  36,  1 
mm.  scale,  R  is  the  in- 
cident parallel  ray,  the  line  P  C  is  the  perpendicular  from  the  center  of 
curvature,  Rf  is  the  reflected  portion  of  R  and  passes  away  from  the  lens 
as  if  it  came  from  NF  on  the  axis.  This  is  the  negative  focal  point  by  re- 
flection from  a  positive  surface. 

The  cardinal  points  of  any  lens  are:  First,  the  principal  points,  where 


44 


A  SYSTEM  OF  MATURE  MEDICINE 


the  principal  axis  cuts  each  surface;  second,  the  optical  center;  third,  the 
nodal  points;  fourth,  the  principal  focal  points. 

The  cardinal  planes  are  lines  crossing  the  axis  at  right  angles,  at  the 
cardinal  points. 

To  construct  a  plano-convex  lens  there  are  to  be  considered :  The 
index  of  refraction;  the  power  desired;  the  radius  of  curvature;  the  thickness 
of  the  lens. 

Having  the  index  and  principal  focal  distance  wanted,  to  get  the  radius 
necessary,  multiply  the  focal  distance  by  the  excess  index  of  the  dense 
medium. 

Having  the  index  and  radius,  to  get  the  principal  focal  distance,  divide 
the  radius  by  the  excess  index  of  the  dense  medium. 

Having  the  radius  and  principal  focal  distance,  to  get  the  excess  index, 
divide  the  radius  by  the  focal  distance. 

Thus,  with  an  index  of  1.52  and  a  focal  distance  of  50  cm.  wanted : 
50x  .52  =  26  cm.,  the  radius. 

Or,  having  the  index  and  radius,  1.52  and  26 ;  to  find  the  focus : 
26-f-  .52  =  50,  the  focus  wanted. 

Or,  having  radius,  26,  and  focus,  50,  to  find  the  excess  index : 
26-^50  =  .52,  the  excess  index. 

To  utilize  the  principles  further  it  is  convenient  to  have  a  unit  of  value, 
which  has  been  established  as  a  lens  having  a  principal  focal  distance  of 
one  meter,  (100  centimeters,  1,000  millimeters).  It  has  been  given  the  name 
Diopter,  needlessly,  because,  when  we  give  the  sign  -(-  or  — ,  and  the  figure 
representing  the  unit,  that  is  sufficient ;  then  the  word  "diopter"  means, 
literally,  "to  see  through,"  and  does  not  mean  a  unit  of  measure. 

Sometimes  it  is  necessary  to  make  a  false  statement  in  order  to  give 
force  to  a  truth.  Under  Fig.  32  such  a  false  statement  is  made  in  showing 
how  the  second  principal  focal  distance  of  a  single  curved  surface  is  elim- 
inated by  adding  a  second  surface,  making  a  lens.  It  was  shown  there  that 
the  second  break,  suffered  by  R'  at  the  flat  surface  brought  the  focal  point 
to  the  same  distance  from  the  surface  that  R2  was  brought  by  one  refraction 
at  the  curved  surface.  This  is  not  true,  except  when  we  disregard  the  thick- 
ness of  the  lens,  which  Nature  does  not  do. 


-IV- 


/So 


REFRACTION  BY  PLANO-CONVEX  LENSES 


Fig.  37,  1  mm.  scale,  shows  R',  paralleling  the  axis  as  it  approaches  the 
lens,  is  broken  toward  F',  90  mm.  from  the  first  surface,  or  the  optical 
center;  at  the  second  surface  it  suffers  another  break  and  passes  away  to 
F2,  60  mm.  from  the  nodal  point,  N,  instead  of  from  the  first  surface,  because 
that  is  where  the  secondary  axial  ray  leaves  the  axis.  This  is  a  third  change 
made  by  lenses.  The  principal  focal  distance  on  the  curved  side  is  still 
measured  from  the  surface  because  the  optical  center  is  there.  It  is  also 
a  nodal  point.  R2  would  only  suffer  refraction  at  the  curved  surface  and  would 
focus  60  points  beyond  it.-  See  Figs.  34  and  35  for  reasons  for  measuring 
from  N  to  F2. 

The  fourth  change  made  by  lenses  is  that  while  in  single  curved  surface 
refraction  measurements  could  be  made  from  either  the  surface  or  the  optical 
center.  In  lenses  we  have  to  stick  to  optical  centers  and  nodal  points. 


In  the  matter  of  focal  distances,  all  lenses  are  compared  with  the  stand- 
ard. Fig.  38  may  help  make  the  point  clear.  Let  -f  L  be  the  position  of 
convex  lenses  and  the  points  on  the  axis  show  the  principal  focal  distances 
from  the  lens,  1  millimeter  representing  1  centimeter.  The  top  row  of 
figures  are  all  multiples  of  1  and  indicate  the  various  powers  of  lenses 
stronger  than  1.  Any  of  these  figures,  divided  into  100,  the  focal  length 
of  +  1.  (usually  written  -(-  1.00  because  there  are  fractions  sometimes).,  will 
give  the  corresponding  figure  below  the  axis,  which  is  the  focal  length  of 
that  lens.  Also,  any  of  the  lower  figures,  divided  into  the  standard,  100, 
will  give  the  corresponding  unit  in  the  row  above.  The  same  is  true  of  any 
other  system  of  numbering  lenses.  Some  use  the  inch  system,  in  which,  to 
be  exact  39.37  inches  must  be  the  unit,  because  that  is  exactly  1  meter.  But, 
any  focal  distance,  divided  into  that  unit  will  give  the  unit,  of  power  of  the 
lens ;  and  any  unit  of  power,  divided  into  the  above  figure  will  give  the  focal 
distance  exactly.  On  account  of  its  small  subdivisions  in  tenths,  the  metric 
system  is  preferable. 

In  the  matter  of  conjugate  focal  distances  and  their  relations,  in  plano- 
convex lenses,  we  have : 

1.  The  principal  focal  distance  and  one  conjugate  focal  distance  being 
known,  to  find  the  other  conjugate  focal  distance:  Multiply  the  given  con- 
jugate focal  distance  by  the  principal  focal  distance  and  divide  by  the  differ- 
ence between  them.  Or,  express  both  distances  in  units  and  subtract  the 
less  from  the  greater,  then  find  the  principal  focal  distance  of  the  difference, 
which  will  be  the  second  conjugate  focal  distance. 

Thus,  if  we  have  a  principal  focal  distance  of  25  cm.  and  one  conjugate 
focal  distance  of  100  cm. : 


46  A  SYSTEM  OF  MATURE  MEDICINE 

100x25  =  2,500        00  ,     ~,     ,.    L 

ioo  —  85  =  75  =      ^  cm''  second  Cf  distance. 

Or,  25,  divided  into  100,  equals  4  units  ;  100,  divided  into  100,  equals  1 
unit;  the  difference  is  3  units;  and  3,  divided  into  100,  gives  33i. 

2.  Having  both  conjugate  focal  distances,  to  find  the  principal  focal  dis- 
tance: Multiply  the  two  given  distances  together  and  divide  by  their  sum: 


'=  25'  the  PrinciPal  focal  distance. 


Or,  express  the  given  distances  in  units  ;  add  them  ;  convert  the  product 
to  focal  distance:  Thus,  100  equals  1.00;  33^  equals  3.00;  add  them,  makes 
4.00,  and  100,  divided  by  4,  equals  25,  the  principal  focal  distance. 

3.  Having  the  two  conjugate  focal  distances  and  the  radius,  to  get  the 
excess  index:   Find  the  principal  focal  distance,  as  above,  then  divide  the 
radius  by  it. 

4.  Having  the  two  conjugate  focal  distances  and  the  index,  to  get  the 
radius  :    Find  the  principal  focal  distance,  as  above,  and  multiply  it  by  the 
excess  index. 

An  interesting  exhibit  by  lenses  is  the  relationship  between  two  sets  of 
conjugate  focal  distances.  For  example  :  Being  given  two  first  conjugate 
focal  distances  and  the  ratio  of  change  in  the  two  second  conjugate  focal 
distances  by  shifting  the  object  from  one  of  the  two  given  distances  to  the 
other  and  being  required  to  find  the  second  conjugate  focal  distances  and  the 
power  of  the  lens,  there  are  two  sets  of  procedures,  each  requiring  two 
calculations.  One  is  when  the  object  is  first  placed  at  the  farthest  first 
conjugate  focal  distance  and  is  moved  to  the  nearest  one.  The  other  is 
when  the  object  is  first  placed  at  the  nearest  first  conjugate  focal  distance 
and  is  moved  to  the  farthest  one.  In  each  the  first  calculation  gives  the 
second  conjugate  focal  distance  corresponding  to  the  last  position  of  the 
object,  and  the  second  gives  the  power  of  the  lens. 

First,  express  the  given  conjugate  focal  distances  in  units  and  find 
their  difference;  multiply  the  principal  focal  distance  of  that  difference  by 
the  times,  the  second  second  conjugate  focal  distance  is  to  be  greater,  or  less, 
than  the  first  second  conjugate  focal  distance;  this  will  give  the  second 
second  conjugate  focal  distance,  corresponding  to  the  last  position  of  the 
object.  Second,  express  this  distance  in  units  and  add  them  to  the  units  of 
the  object  distance,  to  get  the  poiwer  of  the  lens. 

Second,  to  prove  the  correctness  of  such  a  calculation,  find  the  first 
second  conjugate  focal  distance  by  dividing,  or  multiplying,  the  second 
second  conjugate  focal  distance  by  the  times  greater,  or  less,  specified  in 
the  question  ;  express  the  result  in  units  and  add  to  the  units  of  the  cor- 
responding first  conjugate  focal  distance,  to  get  the  power  of  the  lens.  If 
the  result  is  the  same  as  in  the  other  calculation  the  solution  is  proved. 

To  make  this  plainer:  Suppose  an  object  be  placed  100  cm.  from  a  lens 
and  is  then  moved  to  50  cm.  from  it,  with  the  result  that  the  second  con- 
jugate focal  distance  is  three  times  greater  than  the  other  second  conjugate 
focal  distance,  corresponding  to  the  first  position  of  object;  what  are  the 
two  second  conjugate  focal  distances  and  what  is  the  power  of  the  lens? 


REFRACTION  BY  PLANO-CONVEX  LENSES 


47 


Fig.  39,  ^  mm.  scale,  will  help  illustrate  this.  The  first  position  is  100 
points;  the  second  one  is  50  points.  Let  each  point  represent  1  centimeter. 

100  =  1.00;  50  =  2.00;  the  difference,  1.00  =  100  F'. 

The  change  of  position  is  said  to  make  the  second  conjugate  focal  dis- 
tance three  times  farther,  therefore : 

100x3  =  300,  the  second  second  conjugate  focal  distance,  or  .33^  units, 
which,  added  to  the  units  represented  by  the  second  first  conjugate  focal 
distance,  50,  which  is  2.00,  we  have  the  power  of  the  lens,  2.33^. 

As  the  second  second  conjugate  focal  distance  is  three  times  farther 
than  the  first  second  conjugate  focal  distance,  it  is  four  times  as  far: 

300-^-4  =  75,  the  first  second  conjugate  focal  distance,  or  1.33^  units, 
which,  added  to  the  units  represented  by  the  first  first  conjugate  focal  dis- 
tance, 100,  or  1.00,  gives  2.33^  as  the  lens  power. 

Reversing  the  proposition,  making  50  the  first  position  and  100  the  sec- 
ond and  the  change  to  make  the  second  second  conjugate  focal  distance  one- 
fourth  as  far  as  the  first  second  conjugate  focal  distance,  we  have : 

50  cm.  equals  2.00;  100  cm.  equals  1.00;  the  difference,  1.00  equals  100 
cm.  F'.  The  change  reduces  the  first  second  conjugate  focal  distance  to 
one-fourth,  a  reduction  of  three-fourths,  therefore : 

lOOxf  =  75  cm.,  the  second  second  conjugate  focal  distance  or  1.33£ 
units,  which,  added  to  the  units  represented  by  the  second  first  position, 
100,  or  1.00,  gives  2.33^  units  as  the  power  of  lens. 

The  second  second  conjugate  focal  distance  is  one-fourth  of  the  first 
second  conjugate  focal  distance,  therefore: 

75x4  =  300  cm.,  the  first  second  conjugate  focal  distance,  or  .33%  units, 
which,  added  to  the  first  first  conjugate  focal  distance,  50,  or  2.00,  gives 
2.33|  units,  the  power  of  lens. 

In  making  drawings  to  show  conjugate  focal  points  it  is  necessary  to 
use  the  law  of  single  curved  surfaces  to  get  the  direction  of  the  ray  while 
passing  through  the  lens.  All  so-called  "authorities"  have  neglected  this, 
and  I  have  traced  their  error  back  as  far  as  1806,  to  "Adams'  Philosophy," 
where  he  shows  refraction  at  only  one  surface,  as  all  the  rest  have  done 
since.  Whom  Adams  imitated  I  do  not  know. 
H 


Fig.  40,  1  mm.  scale,  shows  a  ray  R',  R2,  passing  from  F  to  F2.  Its 
first  refraction  takes  it  toward  F',  because  the  first  conjugate  focal  distance, 
60,  multiplied  by  the  second  principal  focal  distance,  45,  and  the  product, 


48 


A  SYSTEM  OF  MATURE  MEDICINE 


2 TOO,  divided  by  the  difference  between  the  first  conjugate  focal  distance, 
60  and  the  first  principal  focal  distance,  30,  which  is  30,  gives  90  as  the  dis- 
tance from  the  first  surface  of  the  lens  to  the  point  on  the  axis  toward  which 
the  ray  would  be  directed  while  passing  the  lens.  F'  indicates  the  course. 
To  get  the  final  course  of  the  ray  to  F2,  divide  the  conjugate  focal  distance 
F'  already  found,  90,  by  the  index  of  refraction,  1.50.  Or,  multiply  the  first 
conjugate  focal  distance  by  the  principal  focal  distance  and  divide  the  product 
by  their  difference. 

In  Fig.  40  the  Base-Line  method  is  used  to  find  the  course  of  the  ray 
from  the  first  surface.  It  is  drawn  through  the  optical  center  for  con- 
venience, although  it  might  be  placed  anywhere,  just  so  it  is  parallel  with  the 
incident  ray.  The  perpendicular  to  the  surface  at  the  point  of  refraction  on 
P4  is  12  points  long  to  the  Base-Line,  B  B , 

12x1.50  =  18-=-  .50  =  36  points  from  the  mark  in  the  lens,  (which  is  12 
points  from  12),  to  F'  on  the  Base-Line,  which  is  the  course  of  the  ray  while 
passing  the  lens.  Another  Base-Line,  paralleling  the  refracted  ray,  could 
be  used  to  complete  the  drawing,  but  it  is  left  out  because  the  perpendicular 
from  the  second  surface  would  fall  on  the  refracted  section  and  probably 
cause  confusion ;  also  because  it  affords  opportunity  to  remind  the  student 
that  there  are  two  ways  to  do  almost  everything  and  sometimes  it  is  best  to 
employ  both.  Or,  the  guide-line  A  A  from  where  the  incident  ray  crosses 
the  principal  focal  plane  through  the  optical  center  could  be  used  and  the 
final  course  of  the  ray  will  be  found  parallel  with  it. 

The  relative  sizes  of  objects  and  their  images  formed  by  lenses  are  in 
the  same  ratio  as  their  respective  conjugate  focal  distances.  In  Fig.  40  the 
object  and  its  image  would  be  of  equal  size,  because  the  distances  from  the 
optical  center  on  the  one  side  and  from  the  nodal  point  on  the  other  are  the 
same. 

All  spherically  curved  lenses  have  the  same  power  in  all  meridians,  hence 
revolving  them  on  their  axes,  directed  toward  any  object  one  surface  faces, 
would  make  no  difference  in  their  image-forming  capacities. 

Another  form  of  plano-convex  lens  is  made  with  one  flat  and  one  cylin- 


REFRACTION  BY  PLANO-CONVEX  LENSES 


drically  curved  surface.     As  a  spherical  lens  is  a  segment  of  a  sphere,  so  a 
cylindrical  lens  is  a  segment  of  a  cylinder. 

In  Fig.  41  the  circles  mark  the  cylinder,  with  the  line  c  c  its  axis ;  1 
and  2  mark  the  surfaces  of  the  segment;  the  dotted  parallel  lines  from  1  and 
2  show  the  meridians  on  the  two  surfaces  which  parallel  each  other  and  cor- 
respond to  the  axis;  no  other  meridians  of  the  curved  surface  are  without 
curve,  but  some  have  more  than  others. 

To  make  this  point  clearer  Fig.  42  is 
submitted.  It  shows  a  plane  with  the 
curved  surface,  x  marking  the  meridian 
without  curve,  and  the  entire  surface,  meas- 
ured on  the  lines  2,  2,  2,  etc.,  paralleling 
x  are  as  flat  as  x,  although  the  two  surfaces 
of  the  lens  are  nearer  together  as  they  re- 
cede from  the  axis,  the  line  x,  because  of 
the  curve  at  right  angles  with  the  axis, 
as  shown  in  Fig.  41.  The  meridian  M  and 
the  lines  1,  1,  1,  etc.,  paralleling  it,  have  exactly  the  same  curvature,  the 
thickest  .part  of  the  lens  being  on  the  line  x.  Note  particularly  that  the 
meridian  x  has  no  power  and  that  meridian  M  has  the  maximum  power;  all 
of  the  other  meridians,  a  few  of  which  are  marked  by  the  oblique  lines,  have 
power  in  pairs  of  equal  value,  that  is,  any  two  meridians  at  the  same  distance 
from  the  axis,  x,  one  on  each  side,  have  the  same  power,  gradually  increasing 
as  they  increase  their  distances  from  the  axis  until  they  approach  M,  where 
they  have  almost  the  maximum  power ;  at  a  point  half  way  between  x  and  M 
there  is  one-half  of  the  maximum  power,  hence,  two  cylinders  of  the  same 
kind  and  power,  superimposed,  with  their  axes  at  right  angles,  will  give 
the  effect  of  a  spherical  lens.  If  not  exactly  at  right  angles  the  effect  will  be 
that  of  a  sphero-cylindrical  or  compound  lens,  a  description  of  which  will  be 
found  in  another  chapter. 

Cylindrical  lenses  have  no  image-forming  capacity. 

Revolving  a  cylindrical  lens  around  its  axis  would  be  like  turning  a 
vertical  section  of  a  barrel  around  a  post  placed  where  the  center  of  the 
barrel  would  be;  at  the  first  quarter  turn  the  edge  of  the  lens  would  be  to- 
ward the  object  it  faced  in  its  first  position.  What  is  ordinarily  termed  the 
axis  of  a  cylinder  is  an  axial  line,  which  is,  at  the  curved  surface  just  the 
radial  distance  from  the  real  axis,  as  the  surface  of  a  .spherical  lens  is  the 
radial  distance  from  the  center  of  the  globe  from  wrhich  it  was  cut.  Rotating 
a  cylindrical  lens  around  a  spherical  axis  has  the  effect  of  distorting  objects 
seen  through  it. 

Fig.  41  shows  how  a  cylindrical  lens  focuses  rays  on  line  3,  a  plane  with 
the  axis,  and  c,  c,  c,  c,  represent  a  ribbon  of  light  passing  the  axis  without 
refraction,  other  ribbons,  approaching  parallel  with  this  one.  above  and  below 
it,  will  be  broken  to  it  at  the  line  3.  Of  course  the  use  of  the  world  "focus" 
for  anything  but  points  is  a  misnomer,  but  it  is  permissible  in  optical  work. 


A  SYSTEM  OF  MATURE  MEDICINE 


Fig.  4:3  shows  -j-  and  --  plane  cylindrical  lenses  as  they  come  from  the 
factory  uncut ;  that  is,  not  in  the  form  of  a  lens.  This  is  for  the  convenience 
of  the  optician,  who  cuts  lenses  by  patterns  of  different  sizes.  By  placing 
the  patterns  in  different  positions  the  axial  line  is  fixed  in  the  position  in- 
dicated by  the  prescription,  so  that  the  maximum  curve  will  be  where  it  is 
needed,  when  the  other  curves  will  fit  according  to  Natural  law.  Some- 
times the  plane  surface  of  a  cylindrical  lens  is  put  on  a  machine  and  changed 
to  a  spherical  surface,  when  the  lens  becomes  a  bi-curved  or  sphero-cylin- 
drical lens,  with  power  in  all  meridians  of  one  surface  and  with  unequal 
additions  to  them  on  the  cylindrical  side.  Another  chapter  will  consider  such 
lenses. 


CHAPTER  V. 

Refraction  and  Reflection  by  Piano-Concave  Lenses. 


Fig.  ~W-  ^  mm.  scale,  shows  the  principal  focal  points,  optical  center  and 
nodal  points  of  a  plano-concave  lens. 

Rays  R2,  entering  from  the  plane  side,  parallel  with  the  axis,  only  suf- 
fer refraction  at  the  curved  surface,  at  which  they  are  broken  from  the  axis 
instead  of  toward  it,  as  in  plano-convex  lenses  ;  but  the  rule  applies,  only 
with  negative  effect  : 

Radius,  divided  by  excess  index,  equals  Fa,  and  the  rays  leave  the  lens 
in  the  direction  R2  on  the  left  as  if  they  came  from  F3  on  the  right. 

Rays  R',  entering  from  the  left,  are  refracted  at  the  first  surface  as  if 
they  came  from  F'  because  that  is  the  long  focal  distance  of  the  single  curved 
surface  : 


At  the  second  surface  these  rays  are  broken  again,  from  the  axis,  as  if 
they  came  from  F2,  because  : 
F'-j-I  =  F2. 

The  optical  center  and  one  nodal  point  are  at  the  apex  of  curvature  on 
the  axis  for  the  same  reasons  they  are  in  plano-convex  lenses.     See  Fig.  32. 

The  other  nodal  point,   X,  is  found  in  the  same  manner  as  for  plano- 
convex lenses.     See  Fig.  32. 


Plano-concave  lenses  have  one  flat  and  one  curved  surface.  They  differ 
from  plano-convex  by  being 'thinnest  on  the  axial  line  while  the  plano-con- 
vex are  thickest  on  that  line.  There  are  some  other  points  of  difference,  as 


A  SYSTEM  OF  MATURE  MEDICINE 


a  result  of  their  form,  which  make  consideration  of  them  a  necessity  to  ex- 
pound optical  principles. 


1    i.ot 


Fig.  45,  mm.  scale,  shows  that  a  plano-concave  lens  is  not  a  segment  of 
a  globe,  but  is  a  piece  of  flat  glass  with  the  form  of  the  globe  segment  ground 
into  it.  The  optical  center  and  nodal  points  are  found  in  the  same  manner 
as  for  the  plano-convex.  The  optical  center  is  at  the  apex  of  the  curved  sur- 
face on  the  axis  in  both  instances.  But  the  nodal  point  in  Fig.  37  is  inside 
of  the  curvature  representing  the  globe,  while  in  Fig.  45  it  is  outside  of  that 
curvature.  The  result  is  that  F',  in  each  figure,  is  90  points  from  the  curved 
surface,  while  F2,  Fig.  37,  is  61^  points  from  the  curved  surface  and  in  Fig. 
45  it  is  only  59  points  distant.  In  Fig.  45  the  principal  focal  points  are  nega- 
tive; R'  and  R2  representing  the  parallel  rays  entering  the  curved  side,  and 
after  being  refracted  at  each  surface,  emerging  divergent  from  the  axis. 


Fig.  46,  mm.  scale,  shows  rays  R'  entering  the  flat  surface  and  being 
refracted  only  at  the  curved  surface,  pass  away  divergent  from  the  axis  as 
if  they  came  from  F',  60  mm.  from  O,  because  that  is  the  only  refracting 
surface  in  this  instance. 


REFRACTION  BY  PLANO-CONCAVE  LENSES 


53 


Fig.  47,  mm.  scale,  shows  how  to  find  the  optical  center  and  nodal  point 
of  a  plano-concave  lens.  The  axial  line  is  P'  to  the  curved  surface  and  P2 
is  the  perpendicular  to  the  flat  surface;  the  two  perpendiculars  must  always 

be  parallel;  the  oblique  line,  in  the 
lens,  course  D  D,  which  connects  P' 
and  P2  is  the  refracted  section  of  a 
secondary  axial  ray:  Drawing-  the  line 
PI  parallel  with  the  axis,  P',  and 
measuring  the  angles  1  and  l£,  the 
direction  of  the  ray  R'  is  found,  pas- 
sing from  the  optical  center,  (which 
is  also  one  of  the  nodal  points),  as  if  it 
came  from  x' ;  the  direction  R2  is,  of 
course,  parallel  with  the  course  R'r 
hence  passes  from  the  lens  as  if  it 
came  from  x2  and  crossed  the  axis  at  N,  the  nodal  point.  This  nodal  point 
is  also  located  by  dividing  the  thickness  of  the  lens  by  the  index  of  refrac- 
tion of  the  dense  medium  and  the  quotient  gives  the  distance  from  the  flat 
surface  to  the  point.  Also  multiplying  this  distance  by  the  index  of  refrac- 
tion, gives  the  location  of  the  optical  center  and  the  other  nodal  point. 


Fig.  48,  mm.  scale,  shows  reflection  by  concave  lenses.  R',  approaching 
parallel  with  the  axial  line,  is  reflected  on  the  opposite  side  of  the  perpen- 
dicular, P',  and  follows  R'  to  the  axis  at  F'.  This  is  the  positive  principal 
focal  point  and  shows  that  the  principal  focal  distance,  by  reflection,  of  a 
concave  surface,  is  one-half  its  radial  distance.  R2  is  drawn  to  show  that  the 
refracted  portion  of  the  ray  would  pass  away,  R3,  as  if  it  came  from  F2,  after 
being  refracted  twice  by  the  surfaces  of  the  lens ;  but  that  the  reflected  por- 
tion, R2,  would  go  to  the  principal  focal  point. 

The  cardinal  points  and  planes  of  plano-concave  lenses  are  located  ac- 
cording to  the  laws  given  in  Chapter  IV,  folowing  Fig.  36.  Also  the  same 
rules  of  construction  are  followed,  with  negative  results  where  they  are 
positive  in  the  plano-convex  and  with  positive  results  where  they  are  negative 
in  the  plano-convex. 

Concave  lenses  are  numbered  according  to  the  corresponding  convex 
lens,  therefore,  they  are  theoretically  the  exact  opposites;  but  this  is  not 
true,  practically,  as  we  shall  see.  However  it  makes  no  difference  in  the 
physiological  value  of  such  lenses  as  we  will  select  from  the  various  forms 
and  recommend  for  use  in  practice. 

After  having  established  the  principal  focal  distance,  by  reflection,  of 
concave  surfaces,  and  understanding  that  it  is  only  by  single  curved  surfaces 


54 


A  SYSTEM  OF  MATURE  MKDICINE 


images  are  formed  by  reflection,  the  rules  of  calculation  for  conjugate  focal 
distances  for  convex  lenses  apply  equally  well  for  concave  surfaces.  It  is 
worthy  of  mention  that  a  plano-concave  lens  of  the  same  radius  as  a  plano- 
convex, will  focus  by  reflection  at  one-fourth  the  distance  the  convex  will 
focus  by  refraction,  provided  the  index  is  1.50.  With  any  other  index 
there  will  be  a  change.,  because  the  focus  by  reflection  does  not  change  with 
a  change  of  index,  while  the  focus  by  refraction  does. 


Fig.  49,  mm.  scale,  not  only  shows  the  principal  focus  by  reflection,  but 
the  conjugate  focuses  and  the  formation  of  image.  The  ray  1  approaches 
parallel  with  the  axis  and  is  reflected  to  the  principal  focal  point,  PF,  passing 
on  to  meet  ray  2,  starting  from  the  same  point  at  top  of  object  and  approach- 
ing the  surface  from  C,  the  center  of  curvature  is  reflected  straight  back. 
Ray  3  is  perpendicular  to  the  surface  and  is  reflected  straight  back  ;  it  meets 
ray  4,  which  is  reflected  as  4,  meeting  ray  3  at  40,  the  second  conjugate 
focal  distance.  O  is  the  object,  I  the  image;  A  A  are  angles  of  incidence 
and  of  reflection  ;  B  B  are  the  same  ;  P  is  the  perpendicular  for  angles  A  and 
2  is  the  same  for  angles  B. 

120X30  =  3600-H120—  30)90  =  40,  second  Cf. 

Or,  30  cm.  equals  3.33^  units;  120  cm.  equals,  .83i  units. 

3.331—  .83$  =  2.50  =  40  cm.  second  Cf. 

Real  images  are  formed  by  refraction  through  convex  lenses. 

Real  images  are  formed  by  reflection  from  concave  lenses. 

In  both  instances  the  images  are  inverted. 

Figs.  27  and  28,  Chapter  III,  showed  how  concave  and  convex  single 
curved  surfaces  exhibit  virtual  objects.  Now  we  shall  have  virtual  objects 
bv  concave  lenses. 


I.  So 


Fig.  50,  mm.  scaje,  shows  why  objects  seen  through  a  concave  lens  ap- 
pear nearer  and  smaller.     O'  is  the  real  object;  the  ray  1  starts  from  a  point 


REFRACTION  BY  PLANO-CONCAVE  LENSES 


on  the  axis  and  is  broken  at  the  first  surface  so  that  it  passes  through  the 
lens  as  if  it  came  from  F',  because : 

(Cf'XNPF)-KCf'+OPF)  =  F'. 

The  radius,  30,  multiplied  by  the  index,  1.50,  equals- 45,  and  this,  divided 
by  the  excess  index,  .50,  gives  90  as  NPF;  hence: 

(90X90)  =  8100-^  (90+60)150  =  54,  or  F'. 

To  get  the  final  course  of  the  ray  we  have : 

54-f-1.50  -=  36  =  F2. 

The  opposite  principal  focus  of  this  lens  would  be  60,  as  shown  in  Fig. 
46,  therefore : 

(90X60)  =  5400-K90+60)150  =  36,  or  F2. 

Ray  2  approaches  parallel  with  the  axis  and  is  broken  at  the  first  sur- 
face so  that  it  passes  through  the  lens  as  if  it  came  from  the  long  focus,  90, 
indicated  by  the  line  a;  the  second  break,  at  the  flat  surface,  sends  the  ra} 
away  as  if  it  came  from  the  principal  negative  focus,  60,  indicated  by  the 
line  b,  which  makes  it  appear  to  come  from  the  top  of  the  virtual  object, 
just  as  it  actually  came  from  the  top  of  the  real  one;  hence  the  virtual  object 
is  nearer  and  smaller  than  the  real  one. 

In  Chapter  IV  under  Fig.  41  cylindrical  convex  lenses  have  been  de- 
scribed. The  same  description  applies,  negatively,  to  -  -  cylinders  shown 
with  the  -j-  in  Fig.  43. 


For  all  practical  purposes  in  ophthalmology  it  is  unnecessary  to  figure 
focal  distances  from  the  nodal  points ;  but  in  the  study  of  principles  it  is  very 
essential  to  be  familiar  with  the  absolute  facts.  Plano-convex  and  plano- 
concave lenses  are  not  employed  in  practice,  except  when  cylinders  are  used 
alone.  The  dioptric  power  represented  in  the  difference  between  the  curved 
surface  and  the  nodal  point  in  the  lens  is  so  insignificant  that  in  all  piano- 
curved  lenses  it  is  sufficiently  accurate  to  measure  the  focal  distance  on  either 
side  from  the  principal  point  on  the  curved  surface.  Even  then  one  of  the 
focal  distances  will  be  correct,  namely,  the  one  on  the  curved  side  for  -J-  and 
that  on  the  flat  side  for  — .  This  is  because  one  nodal  point  and  the  optical 
center  are  at  the  principal  point  and  rays  refracted  by  the  +  curve  as  they 
pass  out  of  the  lens  are  focused  positively  on  that  side,  while  those  refracted 
by  the  -  -  curve  as  they  pass  out  of  the  lens  are  focused  negatively  on  the 
reverse  side. 

The  same  liberty  may  be  taken  with  bi-convex  or  bi-concave  lenses ;  but 
measures  should  be  taken  from  the  middle  of  the  lens,  on  the  axis,  where  the 
optical  center  is  located.  Neither  focal  distance  will  be  correct  in  such 
instances,  because,  as  will  be  shown  in  the  next  two  chapters,  the  absolute 
distances  are  measured  from  the  nodal  points.  In  -4-  lenses  there  is  a  dead 
space  between  the  nodal  points,  and  in  -  -  lenses  that  space  is  used  twice, 
because  such  lenses  have  negative  focal  distances  and  each  distance  is 
measured  backward  from  the  nodal  point  of  the  last  refracting  surface. 

"With  meniscus  lenses  it  is  a  different  matter,  as  will  be  shown  in 
Chapter  VIII.  Both  nodal  points  and  the  optical  center  are  outside  of  such 
lenses,  -|-  or  — ,  as  usually  formed.  For  -4-  lenses  the  focuses  of  which  are 
positive,  one  of  the  absolute  measures,  that  on  the  —  side,  is  taken  from  the 


56  A  SYSTEM  OF  MATURE  MEDICINE 

optical  center,  and  that  for  the  -  -  side  is  made  from  the  nodal  point  nearest 
the  lens.  For  —  lenses,  the  focuses  of  which  are  negative,  the  focal  distance 
for  the  —  surface  is  measured  absolutely  from  the  optical  center  to  the 
negative  focal  point  on  the  -j-  side  of  the  lens,  and  that  of  the  -f-  side  is 
measured  from  the  nodal  point  nearest  the  lens  to  the  negative  focal  point 
on  the  —  side  of  the  lens.  Thus,  the  space  between  the  optical  center  and 
the  nodal  point  nearest  the  lens  is  utilized  twice  in  —  meniscus  lenses  while 
it  is  a  dead  space  in  -f-  lenses  of  the  same  class.  In  either  case  it  is  entirely 
wrong  to  measure  from  the  middle  of  the  lens  or  from  either  surface.  The 
deeper  the  meniscus  form  of  the  lens  the  worse  the  fault.  In  measuring 
meniscus  lenses  the  nodal  point  farthest  from  the  lens  is  never  used.  We 
have  found  some  writers  calling  it  the  optical  center  but  they  are  very  muck 
mistaken. 

Optical  firms  recommend  meniscus  and  "toric"  lenses,  because  there  is 
more  profit  in  selling  them.  They  are  so  ignorant  of  optical  principles  they 
have  never  discovered  their  inconsistency  in  making  the  lenses  for  trial  sets 
bi-convex  and  bi-concave. 

Alleged  optical  and  ophthalmological  journals  fairly  reek  with  adver- 
tisements of  such  lenses  and  with  articles  exploiting  prisms  and  one-eighth 
diopter  lenses  when  not  one  in  a  thousand  of  them  could  make  a  correct 
drawing  of  a  lens  if  a  fortune  were  the  stake,  not  one  in  a  thousand  ever 
came  within  one-half  diopter  of  the  exact  amount  of  eye  error,  except,  pos- 
sibly, an  accidental  case  now  and  then,  and  not  one  in  a  thousand  could 
show  the  physiological  action  of  a  prism — if  they  knew  they  wouldn't  use 
them. 


CHAPTER  VI. 

Refraction  and  Reflection  by  Bi-Convex  Lenses. 


Fig.  51  shows  the  principal  focal  points,  optical  center  and  nodal  points 
of  a  bi-convex  lens.  This  is  a  reduced  cut  and  should  be  made  on  radii  of 
40  mm.  to  fit  the  figures  given.  Good  practice  for  the  student. 

Rays  R',  entering  from  the  left  are  refracted  at  the  first  surface  and 
go  toward  F'  while  passing  the  lens,  as  if  they  came  from  X',  because  : 

Radius,  multiplied  by  index  and  divided  by  excess  index,  equal  F'. 

The  same  explanation  applies  to  rays  R2,  which  go  toward  F'  on  the 
left  as  if  they  came  from  X2. 

To  locate  points  F2  in  each  of  the  above  instances  : 

The  distance  from  the  second  surface  to  F',  multiplied  by  the  first 
principal  focal  distance  'of  that  surface,  80,  and  divided  by  the  sum  of  the 
distance  from  that  surface  to  F'  and  the  second  principal  focal  distance  of 
the  surface,  120,  will  give  F2.  Thus: 

120  --  lens  thickness,  6,  leaves  .114. 

114x80  =  9,120          001  14/  t  r  T72 

120  —  234  =          /117  mm-  from  second  surface  to  F2. 


To  locate  the  optical  center:  The  thickness  of  the  lens,  multiplied  by 
the  short  focus  of  either  surface  and  divided  by  the  sum  of  the  short  focuses 
of  both  surfaces,  considered  as  single  curved  surfaces,  gives  the  distance  of 
the  optical  center  from  that  surface  represented  by  the  first  figure.  Thus: 

6  X  80  =  480  r  •    ,  , 

—  =3  mm.  from  either  surface  to  O. 

80  -j-  80~  160 


A  SYSTEM  OF  MATURE  MEDICINE 


Or  radii  40-J-40  =  80  and  4%0  °f  thickness  of  lens  fiom  either  sur- 
face to  O. 

To  locate  the  nodal  points  :  The  optical  center  distance  from  either 
surface,  multiplied  by  F'  of  that  surface  and  divided  by  F-  less  the  dis- 
tance from  optical  center  to  surface  gives  the  distance  from  that  surface  to 
its  nodal  point.  Thus 

3  x  so  =  340       =0%       from  either  surface  to  N. 


120  —  3  =.  117 

The  real  principal  focal  distance  is  3811%17-f--(Ki7  == 


from  N  to  F2. 


In  dealing  with  single  curved  surfaces  the  optical  center  was  the  center 
of  curvature.  In  plano-convex  and  plano-concave  lenses  the  optical  center 
took  a  position  at  the  apex  of  curvature. 

In  single  curved  surfaces  there  were  no  nodal  points,  because  the  sec- 
ondary axial  rays  suffered  no  refraction  and  crossed  the  principal  axis  at  the 
optical  center.  In  plano-convex  and  plano-concave  lenses  the  secondary 
axial  rays  crossed  the  principal  axis  at  the  new  optical  center,  but  suffered 
refraction  at  the  flat  surface  and  passed  away  as  if  they  came  from  N, 
(Figs.  34,  35  and  47),  thus  fixing  one  nodal  point  for  piano-curved  lenses. 


Fig.  52,  mm.  scale,  introducing  bi-convex  lenses,  brings  us  back  to  the 
single  curved  proposition,  so  far  as  optical  center  and  nodal  points  are  con- 
cerned. They  are  all  at  one  place  on  the  axis,  namely,  the  center  of  cur- 
vature. 

The  drawing  is  not  as  complicated  as  it  may  appear  at  first  to  the  stu- 
dent. The  principles  involved  have  been  given  in  the  chapter  on  single 
curved  surfaces,  and  this  figure  will  help  illustrate  the  continuity  of  law. 

Considering  each  surface,  A  and  B,  of  the  circle,  as  single  curved  sur- 
faces, we  have,  with  index  1.50,  principal  focal  distances  F'  at  O  and  at  I. 
Therefore  rays  1  and  1,  starting  from  the  axis  at  O,  are  rendered  parallel 
by  the  surface  A.  and  pass  through  the  globe  parallel  with  the  axis.  Re- 
fracted again  at  the  surface  B,  they  are  converged  to  the  point  F'  and  I.  The 
secondary  axial  rays  from  X'  and  X3  to  X2  and  X4  pass  through  the  globe 
without  refraction,  because  they  strike  both  surfaces  perpendicularly.  The 
rays  2  and  2  from  X'  are  refracted  at  the  surface  A  and  pass  to  the  surface  B 
parallel  with  the  secondary  axis  starting  from  the  same  point ;  and  after 
refraction  at  the  second  surface,  converge  to  a  point  at  X2.  Rays  3  and  3 


REFRACTION  BY  Bi-CoNVEX  LENSES 


undergo  the  same  experience  and  focus  again  at  X4.  Rays  starting  from 
other  points  on  the  object,  O,  above  the  axis,  would  focus  in  the  same  man- 
ner below  the  axis  at  corresponding  points,  fixed  by  their  secondary  axes, 
and  other  rays  starting  from  points  on  the  object  below  the  axis,  would  be 
focused  at  corresponding  points  above  the  axis  at  I,  thus  completing  the 
image. 

Again,  rays  2  and  3,  approaching  the  A  surface  from  the  top  and  bot- 
tom of  the  object,  are  parallel  with  the  axis.  They  are  refracted  at  the 
first  surface  and  take  the  course  F2  A,  because  the  radius,  multiplied  by  the 
index  and  the  product  divided  by  the  excess  index,  gives  that  point  as  the 
second  principal  focal  distance  of  surface  A.  At  the  second  surface  they 
are  refracted  again  and  pass  away,  toward  the  points  X2  and  X4,  the  first 
principal  focal  points  of  surface  B,  (radius  divided  by  excess  index  equals 
first  principal  focal  distance),  measured  on  their  respective  secondary  ax,es. 
Note  that  2  and  3  cross  each  other  at  FG.  This  is  the  principal  focus  of  the 
globe.  Rays  3  and  2,  from  X4  and  X2,  parallel  with  the  axis  on  side  B,  are 
first  directed  toward  F2  B  and  finally  toward  X3  and  X'  crossing  each  other 
at  FG  on  the  A  side,  for  the  same  reasons.  The  image  is  inverted  because 
the  secondary  axial  rays  and  their  accompanying  edge  rays  cross  the  prin- 
cipal axis  between  O  and  I,  the  secondary  axial  rays  crossing  at  the  optical 
center  and  all  the  others  between  the  two  points  FG,  the  principal  focal 
points  of  the  globe.  The  focal  distances  are  measured  from  the  optical 
center;  hence  the  object  is  at  twice  the  principal  focal  distance  of  the  re- 
fracting system  and  the  image  is  the  same  distance  on  the  other  side.  This 
is  only  true  absolutely  with  globes  and  single  curved  surfaces,  where  me.is- 
ures  are  from  the  optical  centers. 

Bi-convex  lenses  are  made:  (a),  both  surfaces  spherical;  (b),  one  sur- 
face spherical  and  the  other  cylindrical. 

In  refraction  by  single  curved  surfaces,  with  the  center,  of  curvature  as 
the  optical  center,  the  principal  focal  distances,  measured  from  the  surfaces, 
were  in  the  same  relation  as  the  two  indexes  of  refraction ;  the  long  focus 
being  in  the  dense  medium,  and  the  short  one  in  the  rare  medium,  for 
positive  surfaces.  Measuring  from  the  optical  center  the  reverse  would  be 
true,  the  short  focus  would  be  in  the  dense  and  the  long  one  in  the  rare 
medium.  Using  negative  surfaces,  these  are  reversed:  Measuring  from  the 
surfaces  the  long  focus  is  in  the  rare  medium  and  the  short  one  in  the 
dense;  but.  measuring  from  the  optical  center  the  long  focus  is  in  the  dense 
and  the  short  one  in  the  rare  medium.  These  points  must  be  watched,  as 
they  are  tricky. 

In  refraction  by  plano-convex  and  plano-concave  lenses  the  two  principal 
focal  distances  become  equal,  measured  from  the  optical  centers  and  the 
nodal  points. 

In  bi-convex  lenses  the  optical  center  takes  a  new  position,  between  the 
surfaces.  If  the  radii  are  equal  it  will  be  midway  between  them.  If  they  are 
unequal  it  will  divide  the  space  in  proportion  to  the  radii,  taking  a  position 
nearest  the  stronger  curve. 

Fig.  53,  mm.  scale,  shows  a  bi-convex  lens  with  C'  and  C2  as  the  cen- 


GO 


A  SYSTEM  OF  MATURE  MEDICINE 


\ 


ters  of  curvature;  the  line  connecting  them  and  bisecting  the  circles  is  the 
axis,  on  which  all  of  the  cardinal  points  are  located.     This  lens  is  the  same 

as  two  plano-convex  lenses 
with  their  flat  sides  together, 
so  it  appears  that  if  either 
would  focus  at  twice  the 
radial  distance,  if  standing 
alone,  putting  them  together 
should  double  the  power  so 

\  V  AWfj^^**  /          the   principal  focal   distance 

would  equal  one  radial  dis- 
tance. But  this  is  not  true. 
In  this  figure  the  optical  center  and  nodal  points  are  located  by  erecting 
the  perpendiculars,  P'  and  P2,  to  surfaces  1  and  2,  parallel  with  each  other; 
then  the  oblique  line,  in  the  lens,  connecting  the  two  perpendiculars  and  the 
two  surfaces,  crosses  the  principal  axis,  locating  the  optical  center  midway 
between  the  surfaces.  Measuring  the  angles  formed  with  the  respective 
perpendiculars  by  the  refracted  section,  as  indicated  by  the  index  of  refraction, 
and  increasing  them  for  R'  and  R2,  outside  of  the  surfaces,  we  have  the 
course  of  R'  as  if  it  came  from  X2  and  crossed  the  axis  at  N,  and  the  course 
of  R2  as  if  it  came  from  X'  and  crossed  the  axis  at  N.  Thus  we  establish 
two  nodal  points  for  bi-convex  lenses  and  it  will  be  found  that  all  bi-curved 
lenses  have  two  nodal  points.  The  lines  marking  the  points  in  the  drawing 
are  the  planes. 


x» 


In  Fig.  54,  mm.  scale,  we  have  a  bi-convex  lens  with  two  radii  of  20 
points  each,  the  same  as  in  Fig.  53.  The  rays  1  and  3,  approaching  parallel 
with  the  axis,  are  refracted  at  surface  A  toward  F2  on  the  right,  which  is  the 
long  focal  distance  of  that  surface,  regarded  as  a  single  curved  surface,  the 
index  being  1.50,  (20X1.50-=- .50  =  60)  ;  at  the  second  surface  this  distance 
is  shortened  the  thickness  of  the  lens,  6,  leaving  54  points  from  the  second 
surface  to  F2,  and  this  distance,  multiplied  by  the  short  focal  distance  of  the 
surface  B,  considered  as  a  single  surved  surface,  the  product  divided  by 
54  -(-  the  long  focal  distance  of  surface  B,  gives  the  final  distance  to  F' : 

54X40  =  2160-f-(54-f  60)  114  =18.9474  mm. "the  principal  focal  distance 
from  the  second  surface  to  F'. 

Another  way  to  locate  F'  is  that  employed  in  Fig.  52,  where  a  ray  ap- 
proached the  surface  parallel  with  the  axis,  or  divergent  from  the  axis,  and 
passed  through  the  dense  medium  parallel  with  a  secondary  axis,  the  final 
focus  on  that  secondary  axis  would  be  at  the  first  principal  focal  distance 
of  that  surface.  In  this  instance  R'  and  R3  are  parallel  with  the  secondary 
axes  from  X'  to  X2  and  from  X3  to  X4  while  passing  the  lens,  hence  they 
focus  on  those  lines  at  X2  and  X4,  and  to  do  so  must  cross  each  other  at  F'. 


REFRACTION  BY  BI-CONVEX  LENSES  61 

The  same  proceedings  applied  to  rays  4  and  2  approaching  the  lens  from 
the  right  side,  establish  F2  and  F'  on  the  A  side  and  finally  end  at  X3  and 
X',  the  conjugate  focal  points  with  X*  and  X2. 

Locating  the  nodal  points  by  calculation :  The  distance  to  either  surface 
from  the  optical  center,  multiplied  by  F'  of  that  surface  and  the  product 
divided  by  F2  less  the  distance  from  O  C  to  surface,  gives  the  distance  from 
that  surface  to  its  nodal  point.  Thus : 

3X40=  120-r-(60— 3)57  =  2.1052  mm.  from  each  surface  to  the  nodal 
points  in  Fig.  54.  Adding  this  to  the  principal  focal  distance  found  from  each 
surface,  we  have 

18.9474+2.1052  =  21.0526  from  N  to  F'. 

This  is  4.95  mm.  beyond  the  center  of  curvature  of  the  first  surface. 

A  simple  way  to  locate  the  optical  centers  of  bi-convex  lenses  is  to 
add  their  radii  to  get  the  denominator  of  a  fraction  of  which  the  numerator 
is  one  radius,  and  this  fraction  of  the  thickness  of  the  lens,  measured  from 
the  surface  represented  by  the  numerator,  is  the  distance  to  the  optical  center. 
Thus,  in  Fig.  54,  with  radii  20,  their  sum  is  40,  hence  2%0  of  the  lens  thick- 
ness from  either  surface  is  the  location  of  the  optical  center.  If  one  radius 
was  20  and  the  other  30,  their  sum  would  be  50,  and  2%0  from  one  surface 
or  3%o  from  the  other  would  be  the  same  as  %  and  % ;  the  first  would  be  the 
distance  from  the  strong  surface  and  the  second  the  distance  from  the  weak 
surface  to  the  optical  center. 

Another  method  is :  One  radius  multiplied  by  the  thickness  of  the  lens 
and  the  product  divided  by  the  sum  of  the  two  radii,  equals  the  distance 
to  the  optical  center  from  the  surface  represented  by  the  radius  multiplied. 

Thus,  Fig.  54  the  lens  is  6  points  thick : 

20X6  =  120-^(20+20)40  =  3  points  to  O  C. 

If  one  radius  was  20  and  the  other  30,  it  would  be : 

30X6=180-=-(30+20)50=3%  points  to  O  C  from  weak  side. 

Or,  20X6  =  120-H20+30)50  =  2%  points  to  O  C  from  strong  side. 

In  Fig.  54  the  dashed  lines,  divergent  from  O,  on  the  axis,  to  the  edge 
of  the  lens,  and  convergent  to  I  on  the  axis  after  passing  the  lens,  are 
parallel  with  the  axis  while  passing  the  lens,  hence  the  object  and  image 
are  at  the  first  principal  focal  distance  of  the  respective  surfaces  as  in  Fig. 
52,  but  the  actual  principal  focal  distance  of  the  lens  is  at  F'  on  each  side, 
midway  between  the  object  and  the  nodal  point  on  side  A,  and  midway  be- 
tween the  image  and  the  nodal  point  on  side  B. 

The  space  between  the"  nodal  points  is  dead.  The  optical  center  is 
not  used  in  measuring  the  focal  distances  in  bi-curved  lenses,  +  or  — ,  except- 
ing meniscus  lenses,  of  course. 

Note,  Fig.  54,  that  the  secondary  axial  rays  from  X'  and  X3  are  directed 
toward  N  inside  the  A  surface.  They  are  refracted  at  the  first  surface  and 
broken  again  at  the  second  surface,  after  which  they  pass  away  as  if  they 
came  from  N  inside  the  B  surface.  Their  courses  on  opposite  sides  of  the 
lens  are  dashed  to  show  the  amount  of  the  deviation. 

Comparing  Figs.  52  and  32,  we  see  that  with  the  index  1.50  the  principal 
focus  at  FG,  Fig.  52,  is  a  change  from  F-,  Fig.  32,  where  a  segment  of  a 
globe  is  used. 


A  SVSTEM  OF  MATURE  MEDICINE 


Comparing-  Figs.  52  and  37,  we  find  that  in  62  the 
optical  center  has  changed  from  the  apex  of  curvature 
back  to  the  center  of  curvature  as  in  single  curved  sur- 
faces. The  nodal  point  developed  in  Fig.  37  is  lost  in 
Fig.  52. 

In  Figs.  53  and  54  we  have  found  two  nodal  points 
and  that  focal  distances  are  measured  from  them  to  the 
exclusion  of  the  optical  center,  while  in  Fig.  37  the  focal 
distances  were  measured  from  one  nodal  point  and  from 
the  optical  center.  There  will  be  other  changes  as  lenses 
take  other  forms. 

Fig.  55,  mm.  scale,  is  for  the  purpose  of  explaining 
methods  of  finding  conjugate  focal  distances  for  bi- 
convex lenses.  The  ordinary  procedure  is  to: 

Multiply  the  first  conjugate  focal  distance  by  the 
principal  focal  distance  and  divide  the  product  by  the 
difference  between  the  first  two  figures.  Or,  multiply 
the  two  principal  focal  distances  together  and  divide  the 
product  by  the  difference  between  the  first  conjugate 
focal  distance  and  the  principal  focal  distance  on  the  same 
side ;  then  add  the  product  to  the  principal  focal  distance 
on  the  other  side.  Thus,  for  Fig.  55,  index  1.50,  radii 
20,  there  would  be  a  principal  focal  distance  of  20 ;  and, 
CP  100,  multiplied  by  20  and  the  product  divided  by  the 
difference  between  them,  would  give  25  points  as  the 
second  conjugate  focal  distance,  or  Cf2 ;  but  this  is  not 
a  fact. 

First,  we  must  locate  the  optical  center  and  the  nodal 
points : 

\Ye  have  seen  that  when  the  radii  are  the  same  the 
optical  center  is  midway  between  the  surfaces,  hence,  in 
this  instance  2  points  from  either  surface. 

Following  the  rule  given  at  the  beginning  of  this 
chapter  we  have : 

2x40  =  80  .,-,,  .     ,       ,  ...  ,  AT 

— —  _    =  I1  yon  points  from  either  surface  to  N. 

\y\)  —  «-  —  Do 

Second,  we  find  the  true  principal  focal  distances : 
Radius,  multiplied  by  index  and  divided  by  excess 

index  gives  the  long  focal  distance  of  the  first  surfaces; 

hence : 

9QX1.50  =  30-:-  .50  =  60. 

This   is   shortened   by  the   thickness   of  the   lens,   4 
points,  leaving  56  from  the  second  surface,  and  the  final 
calculation   is :     This    distance   multiplied   by  the   short 
focal   distance   of  the   second   surface   and   the   product 
&JS  divided  by  the  sum  of  this  distance  and  the  long  focal 

distance  of  the  second  surface  gives  the  final  distance  of  the  ray  from  the 
second  surface;  therefore: 


REFRACTION  BY  Bi-CoxvEx  LEXSES 


56X40  =  2240-=- (56+60)  116  =  19.31032  from  second  surface. 

adding-  the  distance  to  the  nodal  pt.      1.38 

1  <•  or-^7T7rr\  from  nodal  points, 

we  have  the  principal  focal  distance,    20.69032 

Now  for  the  conjugate  focal  points: 

The  first  one  is  given,  100.    Following  the  rule  for  single  curved  surfaces : 


=  100  points  to  F2. 


100  x  60  =r  6,000 

100  —  40  =  60 

Deducting  the  thickness  of  the  lens,  leaves  96,  and  using  the  rule  last  given 
above : 

96  x  40  =  3840 


96  +  GO  =  156 

nodal  point, 


=  24.615  from  second  surface  to  Cf2,  adding  distance  to 

1  38 

7from  nodal  point  to  Cf2. 


25.995 

The  line  x  x  is  a  secondary  axial  ray,  to  show  the  size  of  the  image  com- 
pared with  the  object  O'.  It  is  the  same  as  the  second  conjugate  focal  dis- 
tance is  to  the  first  one. 

The  word  "lens"  comes  from  "lentil"  a  vegetable  of  the  bean  family, 
which  is  bi-convex ;  therefore,  speaking  strictly,  this  is  the  only  form  of  lens 
entitled  to  the  name ;  but,  like  the  word  "diopter,"  it  is  applied  to  all  spherical 
and  cylindrical  segments  and  their  combinations. 

The  bi-convex  is,  unquestionably,  the  best  form  of  all  because  it  affords 
the  flattest  possible  surfaces  and  is,  in  every  other  way,  the  most  practical, 
being  nearer  free  from  aberrations  which  attend  all  in  greater  or  less  degree. 

A  form  of  bi-convex  lens  which  is  often  very  useful  has  a  spherical  sur- 
face on  one  side  and  a  cylindrical  surface  on  the  other  side.  It  is  called  a 
sphero-cylindrical  lens. 


Fig.  56  illustrates  the  surfaces  of  such  a  lens.  A  is  the  spherical  side, 
and  the  lines  crossing  the  center  represent  the  principal  meridians  of  a  normal 
lens.  Those  marked  90  and  180  are  the  first  principal  meridians,  and  those 
marked  45  and  135  are  the  secondary  principal  meridians. 

The  spherical  surface  always  has  equal  power  in  all  meridians;  but  a 
compound,  or  sphero-cylindrical  lens  never  has  equal  power  in  all  meridians ; 
the  power  of  the  spherical  side  is  always  on  the  meridian  corresponding  to 
the  axis  of  the  cylinder  and  furnishes  all  of  the  power  there  is  in  the  combina- 
tion at  that  meridian,  because  the  axis  of  the  cylinder  is  a  plane  surface. 


A  SYSTEM  OF  MATURE  MEDICINE 


B  is  the  cylindrical  side  and  the  lines  c  c  and  x  x  correspond  to  the  180th 
and  90th  meridians  of  the  spherical  surface  and  are  the  first  principal 
meridians;  c  c  is  the  meridian  of  maximum  power  and  x  x  is  the  axis,  which 
is  flat,  hence  has  no  power.  The  oblique  lines  o  o  and  o  o,  are  the  second 
principal  meridians  of  the  cylindrical  surface.  The  latter  exhibit  one-half  of 
the  full  power  of  that  surface.  The  meridians  between  o  and  c  gradually  in- 
crease in  power  as  they  approach  c  and  those  between  o  and  x  gradually  de- 
crease in  power. 

Considered  as  a  whole,  we  have  the  power  of  the  sphere  at  the  meridian 
on  which  the  axis  of  the  cylinder  is  placed,  arid  at  the  opposite  meridian,  that 
is,  90  degrees  from  the  first,  or  axial  meridian,  we  have  the  full  power  of  the 
combination.  Thus,  in  Fig.  56,  with  axis  at  90,  we  have  only  the  power  of 
the  sphere  when  we  place  them  together;  but  at  180  we  have  the  curves  of 
both  sphere  and  cylinder.  The  sphere  has  equal  power  in  all  meridians,  the 
cylinder  begins  to  add  to  that  power  in  all  of  its  meridians  crossing  the  axis, 
increasing  as  they  get  nearer  to  a  right  angle,  finally  giving  full  power  at  180. 

This  matter  will  be  explained  more  fully  in  the  chapter  on  prescription 
writing. 

Proportions  of  Power  of  Cylinders  at  Various  Degrees  from  the  Axis : 


1° 

.00030 

2° 

.00122 

3° 

.00274 

4° 

.00487 

5° 

.00760 

6° 

.01093 

7° 

.01485 

8° 

.01937 

9° 

.02447 

10° 

.03025 

11° 

.03631 

12° 

.04323 

13° 

.05060 

14° 

.05853 

15° 

.06699 

16° 

.07398 

17° 

.08548 

18° 

.09549 

19° 

.10600 

20'° 

.11698 

21° 

.12843 

22° 

.14033 

23° 

.15267 

24° 

.16544 

25° 

.17861 

26° 

.19217 

27° 

.20611 

28° 

.22040 

29° 

.23504 

30° 

.25000 

31° 

.26527 

32° 

.28082 

33° 

.29663 

34° 

.31269 

35° 

.32899 

36° 

.34550 

37° 

.36219 

38° 

.37904 

39° 

.39604 

40° 

.41318 

41° 

.43041 

42° 

.44773 

43° 

.46512 

44° 

.48255 

45° 

.50000 

46° 

.51745 

47° 

.53488 

48° 

.55227 

49° 

.56959 

50° 

.58682 

51° 

.60396 

52° 

.62096 

53° 

.63781 

54° 

.65450 

55° 

.67101 

56° 

.68731 

57° 

.70337 

58° 

.71918 

59° 

.73473 

60° 

.75000 

61° 

.76496 

62° 

.77960 

63° 

.79389 

64° 

.80783 

65° 

.82139 

66° 

.83456 

67° 

.84733 

68° 

.85967 

69° 

.87157 

70° 

.88302 

71° 

.89400 

72° 

.90450 

73° 

.91452 

74° 

.9260? 

75° 

.93301 

76° 

.94147 

77° 

.94940 

78° 

.95677 

79° 

.96369 

80° 

.96975 

81° 

.97553 

82° 

.98063 

83° 

.98515 

84° 

.98907 

85° 

.99240 

86° 

.99513 

87° 

.99726 

88° 

.99878 

89° 

.99970 

90° 

1.00000 

CHAPTER  VII. 

Refraction  and  Reflection  by  Bi-Concave  Lenses. 


Fig.  57,  a  reduced  drawing  to  be  made  to  mm.  scale  by  students,  shows 
the  principal  focal  points,  optical  center  and  nodal  points  of  a  bi-concave 
lens. 

Rays  R',  entering  from  the  left,  are  refracted  at  the  first  surface  and  go 
toward  X'  as  if  they  came  from  F'  on  the  left.  At  the  second  surface  they 
are  broken  again  and  pass  away  as  R'  at  the  right  as  if  they  came  from  F2 
on  the  left. 

To  locate  F' :  Radius,  multiplied  by  index  and  divided  by  excess  index, 
gives  F'.  Thus : 

40X1.50  =  6(M-.50  =  130  F'  negative. 

To  locate  F2:  The  distance  from  the  second  surface  to  F',  multiplied 
by  the  first  principal  focal  distance  of  that  surface,  80,  and  divided  by  the 
sum  of  the  distance  from  that  surface  to  F'  and  the  second  principal  focal 
distance,  120,  will  give  F\  negative.  Thus . 

F'  on  A  side  -j-  lens  thickness,  6  equals  126. 

126  x  80  =  10,080  r  r  -r,   T-™ 

126  + 120  =  ^46    :  =     -   %!'  mm>  *rom  "  surface  to  B  F2-  negative. 

The  same  proceeding  applies  to  rays  R2,  resulting  in  the  negative  focus 

at  A. 

To  locate  the  optical  center:    The  same  proceeding  as  for  Fig.  51: 

6  x  80  =  480  r 

— =  -5  mm.  from  either  surface  to  O. 

OU  -j-  ol)  =  IbU 

To  locate  the  nodal  points:    The  optical  center  distance  from  either  sur- 


GG  A  SYSTEM  OF  MATURE  MEDICINE 

face,  multiplied  by  F'  of  the  surface  and  divided  by  F2  plus  the  distance 
from  optical  center  to  surface.    Thus : 

3  x  so  =  240       _  in%23  mm.  surface  to  N. 


120  +  3  =  123 

Note  that  the  last  formula  differs  from  that  for  the  bi-convex  in  that 
the  -f-  sign  is  substituted  for  the  —  in  this  instance  below  the  line  in  the  last 
calculation. 

Note  also  that  to  get  the  final  principal  focal  distance  in  this  instance 
the  distance  from  the  surface  A  to  AN  and  from  B  to  BN  must  be  deducted 
from  the  given  distances  404%! ;  this  is  4012%23  less  111%23  leaves  39%23  or 
39%!  as  the  negative  principal  focal  distance. 


Bi-concave  lenses  are  not  segments  of  globes,  but  are  ground  on  the 
curves  of  globes  as  if  the  glass  lay  between  them.  The  tools  with  which 
they  are  made  are  segments  of  globes. 


Fig.  58,  mm.  scale,  shows  the  optical  center,  nodal  points,  secondary  axis 
and  principal  focal  points  (negative)  of  a  bi-concave  lens.  The  optical  cen- 
ter and  nodal  points  are  located  by  calculation  for  these  lenses  just  as 
they  are  for  the  bi-convex ;  but  there  is  a  difference  in  the  manner  of  utilizing 
the  nodal  points  in  the  bi-concave  lenses. 

R',  approaching  the  A  surface  parallel  with  the  axis  is  broken  at  that 
surface  and  passes  through  the  lens  as  if  it  came  from  F2  A.  At  the  second 
surface  it  is  refracted  again  and  passes  away  as  if  it  came  from  F'  B,  19l/2i 
points  from  N  on  the  B  side  of  the  lens,  because  that  is  the  refracting  sur- 
face. The  same  thing  happens  to  R2,  which  is  refracted  at  the  B  surface 
and  passes  through  the  lens  as  if  it  came  from  F2  B ;  and  after  refraction  at 
the  second  surface  it  passes  away  as  if  it  came  from  F'  A,  measured  from  N 
on  the  A  side.  In  bi-convex  lenses  the  measurements  were  all  taken  from 
the  nodal  points  to  the  focal  points  on  their  own  sides;  but  these  are  negative 
lenses,  hence  the  measurements,  while  taken  from  the  same  nodal  points,  are 
reversed  in  the  direction  taken. 

The  calculation  is  made  as  for  single  curved  surfaces.  R'  approaches 
the  first  surface  parallel  with  the  axis,  and  to  find  its  first  course  after  re- 
fraction the  radius  is-  multiplied  by  the  index  and  the  product  divided  by 
the  excess  index;  thus 

20X1.50  =  30-^  .50  =  60  =  F2A. 

As  the  lens  is  6  points  thick  the  distance  from  F2  A  to  surface  B  is  66 


REFRACTION,  ETC.,  BY  BI-CONCAVE  LENSES 


67 


points.    The  short  focus  of  B  surface  is  40  points  and  the  long  one  is  60. 


66x40 


2640 


=  202%!  points  from  B  surface  to  F'  B. 


66  +  60         126 

The  same  calculation  applies  to  ray  R2. 

The  optical  center  is  located  in  the  same  manner  as  for  Fig.  51.  The 
nodal  points  are  found  by  the  rule  on  the  preceding  page  and  are  l1^!  points 
from  each  surface.  Deducting  this  amount  from  the  2020£1  leaves  19%j 
points  from  F'  B  to  N  on  the  B  side  and  from  F'  A  to  N  on  the  A  side. 

Bi-concave  lenses  are  made:  (a),  both  surfaces  spherical;  (b),  one  sur- 
face spherical  and  one  surface  cylindrical. 


Fig.  59,  mm.  scale,  shows  how  virtual  objects  are  formed  by  bi-cpncave 
lenses.  O'  is  a  real  object,  at  40  points  from  the  A  surface  of  the  lens.  The 
ray,  1,  approaches  parallel  with  the  axis,  is  refracted  at  the  first  surface  and 
passes  through  the  lens  as  if  it  came  from  F2  on  the  same  side,  because  the 
radius,  multiplied  by  the  index  and  the  product  divided  by  the  excess  index, 
gives  that  distance  from  the  surface.  At  the  second  surface  the  distance 
from  F2  is  lengthened  6  points,  making  66,  which,  multiplied  by  the  short 
focal  distance  of  B  surface  and  the  product  divided  by  the  long  focal  dis- 
tance of  that  surface,  60  -j-  66,  gives : 

66X40=  2640-^(60+66)126  =  202%!  from  the  B  surface  back  to  F' 
on  A  side.  Ray  3  undergoes  the  same  changes  and  leaves  the  lens  as  if 
it  came  from  the  same  F'.  Rays  2  and  4,  secondary  axial  rays,  are  directed 
toward  N,  on  the  A  side,  and  meet  the  courses  of  1  and  2  at  X'  and  X2, 
thus  locating  the  position  of  the  virtual  object. 

The  formation  of  real  images  by  reflection  from  concave  surfaces  has 
been  explained  in  another  chapter,  hence  needs  no  further  mention  here. 

Fig.  60  illustrates  the  surfaces  of  a  -  -  compound,  or  sphere-cylinder 
lens.  As  in  Fig.  56,  the  circle,  A,  represents  the  spherical  side  and  B 
represents  the  cylindrical  surface.  The  description  of  Fig.  56  fits  Fig.  60 
as  well,  except  that  the  powers  are  negative  instead  of  positive. 

There  is  a  law  that  all  regular,  non-spherical,  curved  surfaces  have  their 
two  principal  meridians  at  right  angles.  Cylindrical  lenses  are  one  exhibit 
of  that  law  in  which  the  meridian  of  minimum  power  is  neutral  and  that  one 
is  always  on  the  axial  line. 

Spheres  and  cylinders  may  be  combined  -f-  and  +,  --  and  — ,  --  and 
-f-,  -f-  and  — .  In  any  case  the  cylinder,  having  no  power  on  its  axial  line, 
leaves  the  full  power  of  the  sphere  undisturbed ;  but  on  the  opposite  meridian 
both  exhibit  full  power,  and  if  both  are  +  or  both  —  that  is  the  meridian 


A  SYSTEM  OF  MATURE  MEDICINE 


of  maximum  power;  if  one  is  -f-  and  the  other  —  the  power  of  the  sphere  is 
decreased,  sometimes  neutralized  entirely,  and  may  even  exhibit  some  of 
the  power  of  the  cylinder.  Thus,  if  a  +  2.00  sphere  be  combined  with  a 
-j-  1.00  cylinder,  axis  90,  there  would  be  the  power  of  the  sphere  at  the 
90th  meridian  and  at  the  180th  the  power  of  both  sphere  and  cylinder  would 
combine  to  give  +  3.00  effect.  The  same  would  be  true  if  the  lenses  were 
— ,  the  power  at  90  would  be  —  2.00  and  at  180  would  be  --  3.00.  But  if 
the  sphere  is  -(-  2.00  and  the  cylinder  --  1.00,  the  effect  at  90  would  be  + 
2.00  and  at  180  it  would  be  -j-  1.00  only,  because  the  --  1.00  cylinder  would 
neutralize  part  of  the  -(-  sphere  in  that  meridian.  And  if  the  -  -  cylinder 
was  2.00  it  would  leave  the  lens  neutral  in  the  180th  meridian;  or  if  the  — 
cylinder  was  —  3.00  it  would  not  only  neutralize  the  -f-  sphere  in  the  180th 
meridian,  but  would  give  a  -  -  1.00  effect.  The  same  results  would  occur 
in  using  —  spheres  and  -(-  cylinders.  This  is  explained  in  detail  in  the 
chapter  on  prescription  writing.  . 


CHAPTER  VIII. . 

Refraction  and  Reflection  by  Meniscus  Lenses. 


Fig.  61,  a  reduced  drawing  to  be  made  to  a  scale  by  students,  shows  the 
principal  focal  points,  optical  center  and  nodal  points  of  a  positive  meniscus 
lens. 

Rays  R',  entering  the  -(-  surface  are  first  broken  toward  F',  60  points, 
because  that  is  the  second  principal  focal  distance  found  by  multiplying  the 
radius  by  the  index  and  dividing  the  result  by  the  excess  index. 

Deducting'  the  thickness  of  the  lens  the  distance  from  the  second  sur- 
face :  60 — 6  =  54.     Then  following  the  rule  for  single  curved  surfaces,  and 
employing  it  negatively,  we  have : 
Cf  x  OFF 


Cf  —  NPF 
54  x  80  =  4,320. 


-=  Cf2  which  gives  for  this  case: 
•=65%!  to  F2  from  second  surface. 


120  —  54  =  66 

Rays  R2,  entering  the  -  -  surface  are  first  refracted  toward  X3  as  if 
they  came  from  F3  because  that  is  the  second  principal  focal  distance, 
negative  of  that  surface. 

Adding  the  thickness  of  the  lens  the  Cf  to  the  -f-  surface  becomes  126. 

126x40  =  5,040 


126—60  —  66 

To  locate  the  optical  center:  The  short  radius  multiplied  by  lens  thick- 
ness, divided  by  the  difference  in  radii  multiplied  by  index  and  half  of  lens 
thickness  added.  Thus  : 

-  -     20x6  =  120      -    =  3y      f 
(40  —  20)  20"x  1.50  =  30  +  3  =  33 


70  A  SYSTEM  OF  MATURE  MEDICINE 

To  locate  the  near  nodal  point :  The  same  as  above,  only  substitute  long 
radius  in  place  of  the  short  one;  this  gives  N',  measured  from  the  --  sur- 
face. 

40x6=240  „„,      r  , 

(40 -20)  20x1.50  =30 +  3  =  33  =  %  fl"°m  ~  *™^  tO  N  ' 

For   the   far   nodal   point:    Short   radius   multiplied   by  lens   thickness, 
divided  by  the  difference  between  the  radii : 

20  x  6  =  120 


To  get  real  focal  distances: 

For  R'  ==  65%4+7%i  =  72%!  from  N'  to  F2. 
For  R2  ==  764/u— 3%!  =  72%i  from  O    to  F*. 


Fig.  62,  reduced  drawing  to  be  made  to  scale  by  students,  shows  the 
principal  focal  points,  optical  center  and  nodal  points  of  a  negative  meniscus 
lens. 

Rays  R',  entering  the  —  surface,  are  first  broken  and  pass  through  the 
lens  toward  X'  as  if  they  came  from  F',  because  that  is  the  second  principal 
focal  distance  of  that  surface,  negative;  at  the  second  surface,  which  is  -f- 
we  make  the  conjugate  calculation,  after  adding  the  lens  thickness: 

60+6  =  66 

66gx8°75'280     =97%  from  +  surface  to  F2  at  the  left. 

66  —  120  =  54 

Rays  R2,  entering  the  -f-  side,  are  first  broken  positively  and  go  toward 
the  point  F3  on  the  left,  because  that  is  the  second  principal  focal  distance 
of  the  surface;  at  the  second  surface,  after  deducting  the  lens  thickness,  we 
locate  F4  by  the  conjugate  method,  negatively. 

120—6  =  114. 

1!!.X40fi7-^°    —  84%  from  —  surface  to  F*  at  the  right. 

1T4  —  —  o(j  —  o4 

To  locate  the  optical  center  :  Short  radius  multiplied  by  the  lens  thick- 
ness; divide  by  the  difference  in  radii  multiplied  by  the  index  and  half  the 
lens  thickness  deducted.  Thus  : 

«  to  O. 


To  locate  one  nodal  point  :  The  same  as  above,  only  substitute  long 
radius  in  place  of  the  short  one.  This  gives  N',  measured  from  the  -f- 
surface. 


REFRACTION,  ETC.,  BY  MENISCUS  LENSES 


71 


40  x  6=240 


(40  —  20)  20  x  1.50  =  30  —  3  =  27 

For  the  other  nodal  point :    Same  as  for  the 


— — =  8%  from  -f-  surface  to  N'. 


20  x  6  =  120 


=  6  from  —  side  to  N2. 


(—  40  -!-  20)  20 

For  the  real  focal  distances : 

R'  =  97%—  8%  =  88%  from  N'  to  F2. 

R2  =  84%  +4%  =88%  from  O  to  F4. 

Note  the  points  from  which  focal  distances  are  measured  in  all  forms 
of  lenses. 


Meniscus  means  "little  moon,"  and  that  name  was  applied  to  the -form 
of  lenses  to  be  considered  in  this  chapter.  It  applies  properly  only  to  the 
positive  form ;  but  custom  has  given  it  to  the  negative  form  as  well.  There 
are  some  very  peculiar  things  about  meniscus  lenses  which  will  require  par- 
ticular attention  to  master. 


Fig.  63,  mm.  scale,  is  for  purposes  of  comparison.  The  large  circle  forms 
the  —  surface  of  the  -f-  lens  and  the  -|-  surface  of  the  —  one.  The  -f-  lens 
is  completed  by  the  small  circle  extending  outside  of  the  large  one  and  the 
-  lens  is  finished  by  the  small  circle  remaining  inside  the  large  one.  The 
thickness  of  the  lenses  is  the  same.  In  making  lenses  the  —  are  much  thinner 
on  the  axis  than  -f-  of  the  same  power ;  but  that  does  not  change  the  facts  to 
be  shown  here. 

Note  that  the  optical  center  is  not  established  by  the  refracted  section 
of  the  secondary  axial  ray,  in  either  case ;  but  is  fixed  by  the  emergent  sec- 
tion on  the  strong  side  of  the  lens  in  both  cases.  N'  is  the  course  of  the  sec- 
ondary axial  ray  approaching  the  weak  surface  in  both  cases.  N2  is  fixed  by 
the  refracted  section,  in  the  lens,  in  both  cases.  N2  is  the  same  distance 
from  the  lens  surface  in  both  instances;  but  the  other  two  points  differ  be- 


72  A  SYSTEM  OF  MATURE  MEDICINE 

cause  of.  the  relative  location  of  the  two  surfaces  in  each  lens.  The  —  sur- 
face of  the  -)-  lens  is  4  mm.  nearer  the  center  of  curvature  of  the  -f-  than 
the  positive  surface ;  while  the  +  surface  of  the  —  lens  is  4  mm.  farther  from 
the  center  of  curvature  of  the  —  than  the  negative  surface. 

In  meniscus  lenses  focal  distances  are  measured  from  the  optical  center 
and  N'.  Rays  entering  a  +  lens  parallel  with  the  axis  on  the  +  side  would 
find  their  focal  point  on  the  opposite  side  of  the  lens  at  a  fixed  distance  from 
N';  and  rays  entering  from  the  —  side,  parallel  with  the  axis,  would  find 
their  focal  point  on  the  opposite  side  at  a  fixed  distance  from  O.  Rays 
entering  a  --  lens  from  the  —  side,  parallel  with  the  axis,  would  find  their 
negative  focal  point  at  a  fixed  distance  on  the  same  side  of  the  lens,  measured 
from  N' ;  and  rays  entering  from  the  -f-  side,  parallel  with  the  axis,  would 
find  their  negative  focal  point  at  a  fixed  distance  on  the  same  side  of  the  lens, 
measured  from  O. 

It  is  important  to  get  this  straight  in  order  to  make  calculations  for 
principal  and  conjugate  foci.  N2  is  a  dead  point  in  both  lenses. 

As  mistakes  are  made  easily  in  drawing,  it  is  necessary  to  have  formulae 
with  which  to  test  the  work ;  and,  having  them,  better  drawings  are  possible. 

To  locate  the  optical  centers  and  nodal  points  of  meniscus  lenses  we 
employ  the  following:  The  lens  thickness  may  be  4,  6  or  any  other  figure. 
These  calculations  are  to  illustrate  principles. 

For  -f-  lenses : 

(1).    The  short  radius  is  R'  and  the  long  radius  is  R2. 

R' x  lens  thickness  ,.   ,  r  r 

-7^5 — TJTT — T  ,   n  . -7-T-j =  distance  from  4-  surface  to  O. 

(Rz  —  R  )  x  I  +  -J  lens  thickness 

Thus,  in  Fig.  61  R'  is  20  and  R2  is  40  points.    Lens  4  points  thick. 

20X4  =  80  01/  r  r 

(40-20)  20x1.50  =30  + 2  =  32  =2/2  mm'  ft~°m  +  SUrfjK*  tO  °' 

Or,  (2).  Using  short  and  long  focal  distances  of  single  curves,  S'  is  the 
strong  surface  and  S2  is  the  weak  one.  F'  is  the  short  focal  distance  and  F2 
is  the  long  focal  distance  of  each  surface. 

S'F' x  lens  thickness  ,•   ,  r  r 

,c2r,2 — c,T-,2x   i  . -r^-: =  distance  from  +  surface  to  O. 

(S  F2 —  S  F2)  +  lens  thickness 

In  Fig.  61  S'F'  is  40;  S'F2  is  60;  S2F'  is  80;  S2F2  is  120.     Lens  thick  4. 

40  x  4  =  160 

,  „. r — - — ; =2-vo  mm.  from  +  surface  to  O. 

(120  —  60)  60  +  4  =  64 

To  locate  the  nodal  points  for  —  surfaces  of  +  lenses : 

R2x  lens  thickness  «.   .  r  r  -\T/ 

-T™ — TTT: — T  !  n  —  =  distance  from  —  surface  to  N  . 

(Ra  —  R  )  x  I  +  £  lens  thickness 

40x4  =  160 = 

(40  —  20)  20  x  1.50  =  30  +  2  =  32  ~ 

r\  S'F' x  lens  thickness  «»  ,  f  f  -\T/ 

Or,    .C2T72 — ,  — =  distance  from  —  surface  to  N  . 

(S  F  — S  F2)  +  lens  thickness 

80x4  =  320  p  -j  AT/ 

=  o  mm.  from  —  side  to  N  . 


(120  —  60)  60  +  4  =  64 

To  locate  the  nodal  points  for  -4-  surfaces  of  +  lenses : 
R' x  lens  thickness   =  digtance  frQm          surface  ^  ^ 
K.  —  K. 

Thus,          _^_    ~~_        =  4  mm.  from  -4-  surface  of  -f-  lens  to  ^2. 
For  —  lenses:    (1). 

_^_R^enSthickness =  distance  from  _  surfac€  to  O. 

(R2  —  R  )  x  I  —  ^  lens  thickness 


REFRACTION,  ETC.,  BY  MENISCUS  LENSES  73 

Thus,  in  Fig.  62 : 

20x4  =  80  =2%  mm.  from  —  surface  to  O. 


(40  —  20)  20  x  1.50)  =  30  —  2  =  28 

Or,  (2).    Using  short  and  long  focal  distances  of  single  curves: 
S'F'  x  lens  thickness  j-   ,  f  <•  /-\ 

(S'P-S'F)-  lens  thickness   ==  dlStanCC  fr°m  " 


-  =  36/7  f  _     urface  t 


(120  —  60)  60  — 

To  locate  the  nodal  points  for  -(-  surfaces  of  —  lenses : 

-7=5 x  enst  ic  ness  =  Distance  from  _j_  surface  to  N'. 

(R  —  R  )  x  I  —  i  lens  thickness 

^Q   x   4    __    -J^gQ 

(40  —  20)  20  x  1.50  =  30  —  2  =  28  ~~   £>/7  r 

•.C.2T--2 — o>T'2\ i —     ,.  •  < ==  distance  irom  -4-  suriace  to  JN  . 

(S  F  —  S  r  )  — lens  thickness 


80x4  =  320 


—  =  5%  mm.  from  -f-  side  to  N'. 


(120  —  60)  60  —  4  =  56 

.To  locate  the  nodal  points  for  —  surfaces  of  --  lenses: 

R'x  lens  thickness  _  distance  from  _  surface  to  NS>       ' 
1\.  —  K. 

Thus,  20  x  *  =  8°   =  4  mm-  from  the  —  surface  of  N2. 

40  —  20  =  20 

To  locate  the  principal  focal  distances  for  -f  meniscus  lenses: 


Fig.  64  is  a  reproduction  of  the  +  exhibit  in  63,  for  convenience.  It 
is  a  reduced  drawing  and  should  be  made  on  mm.  scale  by  students  :  As 
single  curved  surfaces,  both  have  their  long  focal  distances  on  the  right 
side,  because  the  short  focal  distance  is  on  the  outside  of  -f-  and  on  the 
inside  of  —  curvatures  and  the  long  focal  distances  are  on  the  inside  of  -f- 
and  on  the  outside  of  —  curvatures. 

The  ray  R',  parallel  with  the  axis,  strikes  the  -f-  surface  and  is  refracted 
in  the  direction  60,  because  : 

RXl-^ExI  =  F2,   and   20X1.50  =  .30-:-  .50  =  60. 

The  lens  is  4  points  thick,  hence  the  point  60  is  only  56  points  from 
the  —  surface;  and  to  finish  the  calculation  and  locate  F'  on  the  right,  we 
make  a  positive  proposition  of  the  distance  56  and  follow  the  rule  for  single 

curved  surfaces  :  =  Cf  '•     Thus  : 


-         3""  70  mm-  positive,  hence,  —  side  to  F'.     Adding  to 


this  the  5  points  from  the  —  surface  to  N',  gives  the  principal  focal  distance 

^5.  []  h-.H    ig 

The  ray  R2,  parallel  with  the  axis,  strikes  the  —  surface  and  is  refracted 
so  that  it  passes  through  the  lens  as  if  it  came  from  a  point  120  mm.  distant, 
because,  40x1.50  =  60-f-  .50  =  120. 

Adding  the  thickness  of  the  lens  gives  124  points  to  the  +  surface,  and, 
following  the  rule,  as  before  : 


74  A  SYSTEM  OF  MATURE  MEDICINE 

124x40=4,960  „„-,/  ...  •,  T?,         T-» 

— — J          =  77%    mm.    positive,    hence,    -f-    side   to    F'.      De- 

1  w±       j  uU  — —  o4 

ducting  2%  points  for  the  distance  from  the  -+-  surface  to  O,  leaves  75. 

Note  that  the  principal  focal  distance  of  this  lens  is  75  points,  which 
represents  13.33%  units.  The  ordinary  method  of  calculating  such  lenses  is 
to  disregard  the  thickness  and  assume  that  putting  two  piano-curved  lenses 
together,  one  with  a  radius  of  20,  and  a  principal  focal  distance  of  40,  or  -4- 
25.00  units,  and  the  other  with  a  radius  of  40,  a  principal  focal  distance  of 
80,  —  12.50,  would  give  -f  12.50  with  a  principal  focal  distance  of  80.  But 
the  drawing  and  calculation  show  this  is  not  true.  The  student  may  take 
any  thickness  of  lens  and  make  calculations  for  exercise,  when  he  will  find 
facts  which  will  enhance  his  respect-  for  optics  and  for  those  who  spend  their 
lives  digging  out  the  truths,  and  will  certainly  be  better  able  to  do  good 
work  by  insisting  that  prescription  houses  respect  him  and  his  orders. 

To  locate  the  principal  focal  distances  for  -  -  meniscus  lenses : 


R1 


LJ 

Fig.  65  is  a  reproduction  of  the  —  exhibit  in  63,  for  convenience.  It 
is  also  a  reduced  drawing  to  be  made  to  mm.  scale  by  students :  As  single 
curved  surfaces,  both  have  their  long  focal  distances  on  the  left  side,  for 
the  same  reasons  given  for  the  -f-  having  them  on  the  right.  In  meniscus 
lenses  they  are  always  on  the  side  of  strongest  curve. 

The  ray  R',  parallel  with  the  axis,  strikes  the  -  -  surface  and  is  re- 
fracted in  the  direction  negatively  60,  because  that  is  the  long  focal  dis- 
tance of  the  surface.  Adding  the  thickness  of  lens,  4,  makes  64  from  the 
pV)int  60  to  the  -j-  surface  of  the  lens. 

— .x_~^_  ~  —  91%  negative  F  from  -(-  side.  Deducting  the  dis- 
tance from  the  -f-  surface  to  N',  5%,  leaves  85%  negative  focal  distance 
from  N'. 

The  ray  R2,  parallel  with  the  axis  on  the  -f-  side,  strikes  the  surface  and 
is  refracted  so  that  it  passes  through  the  lens  toward  the  second  principal 
focal  point  of  that  surface,  120.  Deducting  the  thickness  of  the  lens  leaves 
116  as  the  first  conjugate  focal  distance,  negative,  from  which  to  find  the 
final  focal  distance : 

1!?<;X  4°ftr_  tt°    =  836/7  negative  distance  from  —  side.     Adding  the 

lit)  —  DU  —  5u 

distance  from  the  —  surface  to  O,  2%,  gives  85%  from  O. 

Note  that  for  the  -f-  lens  the  focal  distance  from  the  nodal  point  N' 
is  measured  on  the  opposite  side  of  the  lens ;  and  from  the  optical  center  on 
the  same  side  of  the  lens.  Also  note  that  for  the  —  lens  the  focal  distance 
from  N'  is  measured  on  the  same  side  of  the  lens;  and  from  the  optical 
center  on  the  opposite  side  of  the  lens. 

Fig.  66,  mm.  scale,  shows  how  to  find  a  —  radius  which  will  complete  a 
R'  approaches  the  -4-  surface  parallel  with  the  axis,  and  is  refracted  to- 
real  -4-  12.50  lens,  meniscus  form : 


REFRACTION,  ETC.,  BY  MENISCUS  LENSES 


75 


-J?,3 


ward  point  60,  as  in  Fig.  64.  With  the  second  surface  4 
points  from  the  first,  the  distance  is  reduced  to  56.  This 
distance,  divided  by  the  index  of  refraction,  1.50,  gives 
the  radius  of  curvature  for  the  —  surface. 

56-^1.50  =  371/3  radius,-f-  .50  =  74%  F/,+371/3  =  112 
F2,  and,  remembering  it  is  a  negative  proposition,  we 
have: 


Locating  the  optical  center  we  have: 

20  x  4  =  80 


to  O. 


(37%  —  20)  17%  x  1.50  =  26  -f  2  =  28 


4  from  -[-  surface 


Locating  the  nodal  points  we  have : 


37%  x  4  =  149% 


(37%  —  20)  17%  x  1.50  =  26  +  2  =  28 

face  to  N'. 

20x4  =  80  ,«/ 


- — 5l/3    from   —   sur- 


The  distance  F2,  added  to  the  distance  from  the  — 
surface  to  N',  5%,  gives  80  points,  the  principal  focal  dis- 
tance from  N' 

If  the  —  radius  is  other  than  twice  as  great  as  the 
+,  the  procedure  for  finding  the  —  radius  is  to  get  the 
ratio  of  unit  power,  then  multiply  the  distance  found  (as 
56,  above)  by  that,  then  divide  by  the  index  and  multiply 
by  the  excess  index  to  get  the  radius.  Thus,  the  power 
of  the  +  above  is  twice  that  of  the  —  side,  hence : 

56x2  =  112-T--1.50  =  742/3x  .50  =  37%. 
R2,  approaching  the  —  surface  parallel  with  the  axis, 
is  refracted  as  if  it  came  from  the  point  F,  112  points 
from  the  surface,  because  that  is  F2,  negative,  of  that 
surface.  Adding  the  distance  from  the  —  to  the  +  sur- 
face, 4,  gives  116  points  as  the  first  conjugate  focal  dis- 
tance from  the  -f-  surface,  and  following  the  rule : 

116x40  =  4,640  _  Q0fi/ ^  -nv  ^ —  +he    ,    surface> 


116  —  hO  =  56 

Deducting  the  distance  to  the  optical  center  from 
the  -f-  surface,  2%,  leaves  80  points  as  the  principal  focal 
"  distance,  from  the  optical  center,  on  the  +  side  and  from 
N'on  the  —  side. 

Note  that  the  secondary  axial  ray,  S',  is  directed 
toward  the  optical  center  and  crosses  the  axis  at  that 
point;  and,  after  refraction  by  both  surfaces  of  the  lens 
it  passes  away  to  S2  as  if  it  came  from  N'.  This  is  the 
reason  for  measuring  the  respective  focal  distances  from 
O  and  N'.  The  space  between  those  two  points  is  dead. 
The  dashed  lines  along  the  secondary  axial  ray  are  to 
show  the  courses  of  the  sections  before  and  after  refrac- 
tion,  and  the  very  slight  change  suffered  by  these  rays. 


76  A  SYSTEM  OF  MATURE  A!EDICINE 

Note  also  that  to  get  the  principal  focal  distance,  80,  corresponding  to 
12.50  units  of  power,  the  radius  of  the  —  surface  had  to  be  shortened  to  37% 
from  40,  shown  in  Fig.  61. 

Now  let  us  see  what  will  happen  when  we  want  to  make  a  —  12.50 
meniscus : 


Fig.  67,  reduced,  to  be  made  to  mm.  scale  by  students,  shows  such  a 
lens;  starting  with  a  radius  of  20,  ray  R'  approaching  the  concave  surface 
parallel  with  the  axis  is  refracted  and  passes  the  lens  as  if  it  came  from  60 
mm.  from  that  surface,  because  it  is  F2.  Adding  the  thickness  of  the  lens, 
4,  makes  64  as  Cf  for  the  convex  surface.  This  negative  focal  distance, 
divided  by  the  index,  1.50,  gives  the  radius  necessary  for  the  +  surface  to 
get  the  desired  focal  distance : 

64-^1.50  =  42%  mm.  the  radius  of  the  -f-  curve. 

42%x.50  =  85%  F',+42%  =  128  F2. 
To  locate  the  optical  center: 


20  x  4  =  80 


(42%  —  20)  22%  x  1.50  —  34  —  2  =  32 

To  locate  the  nodal  points: 


— — =  2%  to  O  from  —  surface. 


-  5l/3  to  H'  from  the  +  side. 


20  x  4  =  80 


42%  _  20  =  22% 

The  ray  R'  approaching  the  -}-  surface  from  64  points  suffers  positive 
refraction  but  the  effect  is  negative  because  the  first  principal  focal  distance 
of  a  surface  with  a  radius  of  42%  is  85%,  therefore : 

=  85%  from  the  +  surface  to  F. 


Deducting  the  distance  from  the  +  surface  to  N',  5%  leaves  F  80 
from  N'. 

Ray  R2  entering  the  lens  at  the  -f-  surface  is  first  directed  toward  a 
point  128  mm.  positive,  on  the  opposite  side  of  the  lens.  Deducting  the 
thickness  of  the  lens,  4,  leaves  124  from  the  —  surface,  and : 

124x40  =  4,960  „„-,,  r  r  tr  i       -j 

—  =  77%  mm.  from  —  surface  to  F  on  -f-  side. 

OU  i       I*i4  —  t)4 

Adding  the  distance  from  the  —  surface  to  O,  2%,  makes  F  80  on  the 
-f-  side  from  O. 

Note  that  the  radius  of  the  -f-  surface  had  to  be  lengthened  to  get  the 
actual  focal  distance  of  a  —  12.50. 

The  standard  meniscus  lens  is  always  -  -  1.25  or  -j-  1.25  on  its  weak 
side,  hence,  when  combined  with  a  strong  -f-  or  —  curve  on  the  opposite 
surface  the  optical  center  is  very  close  to  the  strong  side;  almost  the  same 
as  a  piano-curved  lens. 

There  is  a  form  of  meniscus  lens,  which  is  widely  advertised  by  manu- 
facturers and  their  allies,  for  commercial  purposes,  because  there  is  great 
profit  in  its  sale,  which  is  actually  injurious  to  wearers,  on  account  of  chro- 


REFRACTION,  ETC.,  BY  MENISCUS  LENSES  77 

matic   aberration,   while   it   scarcely   approximates   the  trial   lenses   used   in 
fitting,  which  are  bi-convex  and  bi-concave. 

These  lenses  are  made  on  minimum  "base"  curves  of  6.00  units;  thus  a 
-f-  2.00  would  be  ground  -  -  6.00  on  one  surface  and  -f-  8.00  on  the  other. 
The  short  radius,  with  index  1.50  is  62.5  and  the  long  one  is  83%. 


Fig.  68,  mm.  scale,  shows  such  a  lens,  made  to  actual  measures,  accord- 
ing to  usage  : 

Locating  the  optical  center:     Lens  thickness,  3. 

62.5x3  =  187.5  K 


-  62%)  20.83%  X  1.50  =  31%  +  1%  = 
83^x3  =  250 


-j 
Slde 


-  62%)  20.83y3  x  1.50  =  3iy4  +  ^  =  32% 
62.5x3  =  187.5 


83%  —  62%  =  20.83% 

A  ray  approaching  the  -f-  side,  parallel  with  the  axis,  would  be  refracted 
at  the  first  surface  and  go  toward  a  point  on  the  axis  187.5  distant. 
As  the  second  surface  is  3  points  nearer  the  distance  is  184.5 : 

184.5  x  166%  =  30,750        Acn  K   {  f  TT  -A 

184.5 -250  =  65^         =  469'5  fl"°m  ~  SUrfaCC  tO  F  °n  that  Slde' 

A  ray  approaching  the  —  side,  parallel  with  the  axis,  would  be  refracted 
at  the  first  surface  and  go  to  the  second  as  if  it  came  from  250  points  away 
on  the  axis.  Adding  3  for  lens  thickness  we  have : 

253x125  =  31,625         -<00o   r  r  T-  -j 

— - — ,Q-  ,  _ '        =  482.8  from  -j-  surface  to  I1  on  that  side. 

*&Oo  lo  *  .O  OO.D 

Adding  to  F  on  the  right  the  distance  from  —  surface  to  N', 
469.5+7.6=477.1==   principal  focal  distance  from  N'. 

Deduction  from  F  on  the  left  the  distance  from  -f-  surface  to  O, 
482.8—5.7  =  477.1  =  principal  focal  distance  from  O. 

But  note  that  a  +  2.00  should  have  a  principal  focal  distance  of  500 
mm.,  and  this  lens  misses  that  focal  distance  23.4  mm. 

Such  a  lens,  if  made  bi-convex,  would  have  its  optical  center  and  both 
nodal  points  within  a  space  of  1.5  millimeters,  all  inside  the  lens. 

The  way  to  treat  the  claims  of  exploiters  of  such  lenses  is  to  place  them 
alongside  lenses  of  the  same  unit  number  from  the  trial  set.  No  argument 
will  be  needed  to  show  which  is  the  best  lens  for  all  purposes.  The  boasts 
of  manufacturers  go  glimmering  like  fog  before  sunlight.  Their  published 
charts  showing  the  "values"  of  the  meniscus  lenses  in  forming  pictures  is 
shown  to  be  a  deliberate  humbug.  Then  it  should  be  remembered  that  no 
lens  forms  the  picture  at  the  retina;  lenses  merely  add  to  or  subtract  from 


78 


A  SYSTEM  or  MATURE  MEDICINE 


the  power  of  the  refracting  system  of  the  eye  by  altering  the  courses  of  rays 
as  they  enter. 


Fig.  69,  reduced,  to  be  made  to  mm.  scale  by  students,  illustrates  con- 
jugate focal  distances  by  a  -f-  meniscus  lens.  The  first  thing  to  do  is  to 
locate  the  optical  center  and  the  near  nodal  point;  then  the  principal  focal 
distances;  assuming  a  lens  thickness  of  2  points: 

"  distance  from          side  to  O. 


n»« 

(R  —  R) 


hi. 
lens  thickness 

10  x  2  =  20 


f 


t 


(20  —  10')  10  x  1.50  =  15  +  1  =  16 

Same  rule  except  using  R2  for  first  multiplication  locates  N'. 

— ^*0*aBr40.g  ,  . 7T=2.5   mm.  from  —  surface  to  N'. 

(20  —  10)  10  x  1.50  —  15  +  1  =  16 

The  principal  focal  distance  is  located  as  follows : 

A  ray  approaching  parallel  with  the  axis  from  the  -  -  side  would  pass 
the  lens  as  if  it  came  from  a  point  60  from  the  —  surface.  Adding  lens  thick- 
ness makes  the  distance  to  the  -f-  surface  62. 

^^—=38.75  from  -f-  surface  to  principal  focal  point. 

62  —  30  —  32 

Deducting  the  distance  from  -f-  surface  to  O,  1.25,  leaves  37.5  as  P  F. 
Next,  the  first  conjugate  focal  distance,  F,  is  90  from  the  optical  center 
and  91.25  from  the  +  surface.    Using  the  rule  for  single  curves: 

Cf '  x  OFF          rt 2 
Cf'-NBF      =Cf2,  wehave: 

91-35x30  =  2737.5^  38.42  or  F'  toward  which  the  ray  will  be  directed. 

91.25  —  20       71.25 

To  find  the  final  point  after  second  refraction :  The  distance  F',  less 
thickness  of  lens,  2,  is  36.42  points.  This  is  a  —  surface  but  the  above  for- 
mula works  by  using  the  distance  36.42  as  if  the  surface  were  +,  and  F' 
will  be  on  the  same  side,  because  the  lens  as  a  whole  is  -}-. 

36.42  x  40  =  1456.8 


™ 

-  DU 


C1  »o    ,  , 

'=  61.78  from  the  concave  surface. 


61.78+2.5  to  N'  gives  64.28  as  Cf2  of  lens. 

Having  the  principal  focal  distance  and  the  first  conjugate  focal  distance 
of  the  lens  as  a  whole  : 

Multiply  the  first  conjugate  focal  distance,  from  the  optical  center  by 
the  principal  focal  distance  and  divide  by  the  difference  between  them: 


90x37.5=3,375 
—  —  — 


.    ,      r  ,,,   ^      ~,2 

=  64.28  points  from  N'  to  Cf2. 


yu  —  37.5  =  52.5 

Proving  the  work  by  using  the  Base-Line  method  and  starting  from  F2 
we  have  the  ray  F2  B  to  the  concave  surface,  which  the  Base-Line  parallels; 
then,  drawing  the  perpendicular  from  C2  to  C3  and  measuring  from  B  to  C3, 
34  mm.,  then  measuring  from  C3  to  A  the  same  distance,  we  locate  the  point 
to  measure  from.  Multiplying  34  by  1.50  and  dividing  by  .50,  gives  102 
mm.  on  the  Base-Line  from  A  to  the  point  to  which  the  ray  will  be  directed 


REFRACTION,  ETC.,  BY  MENISCUS  LENSES 


79 


while  passing  the  lens ;  and,  continuing  that  direction  backward  from  the 
lens,  it  strikes  the  axis  at  F',  where  the  refracted  ray  from  F  was  directed 
by  the  first  surface.  Now,  making  another  Base-Line,  parallel  with  the 
course  of  the  ray  while  passing  the  lens,  erecting  a  perpendicular  from  C'  to 
the  convex  surface  where  the  refracted  ray  strikes  it,  the  distance  on  that 
perpendicular  is  10  points,  which,  divided  by  the  excess  index,  .50,  gives  20 
points  from  the  surface  along  the  Base-Line  to  C4  where  the  emergent  ray 
crosses  on  its  way  to  F.  Thus  the  first  procedure  is  proved. 

Reflection  from  the  +  surfaces  of  meniscus  lenses  is  always  negative 
and  from  the  --  surfaces  is  always  positive,  as  has  been  illustrated  in  the 
chapter  on  single  curved  surfaces;  therefore  it  need  not  be  repeated  here. 


This  is  the  wife  of  a  Minnesota  doctor  who  not  only  had  a  divergent 
squint  but  had  been  given  up  to  die  from  tuberculosis.  She  had  not  done 
any  work  for  a  long  time.  After  six  months'  neurological  treatment,  she 
has  been  doing  the  housework  for  her  husband  and  six  children  over  a  year. 


These  Eyes  Straightened  Instantly. 


A  SYSTEM  OF  MATURE  MEDICINE 


Here  is  a  little  girl  who  was  not 
only  cross-eyed,  but  her  disposition 
was  twisted  so  that  she  was  a  charge. 

These  pictures  were  taken  two 
weeks  apart,  hence  it  was  four  weeks 
from  the  first  to  the  last  and  her  moth- 
er reported  there  was  as  much  change 
in  her  disposition  as  appears  in  her 
face. 

An  operation  might  have  straight- 
ened the  eyes,  temporarily,  but  it  could 
not  have  touched  the  disposition,  be- 
cause glasses  are  not  nearly  all  of  the 
neurologist's  armamentarium. 

Ophthalmology  isn't  any  old  thing 
some  cheap  imitators  choose  to  call 
ophthalmology. 


CHAPTER  IX. 

Refraction  and  Aberration  of  Tri-Curved  and  Other  Lenses. 

In  architecture  there  is  a  half-round  hoop  ornament  for  pillars  which 
is  called  a  "tore."  A  segment  of  such  an  ornament  would  be  regularly 
curved;  but  it  would  be  neither  spherical  nor  cylindrical.  It  would  have 
curve  in  every  meridian;  but  there  would  be  two  extreme  ones,  at  right 
angles,  one  with  maximum  and  the  other  with  minimum  power;  between 
these  two,  as  in  cylinders,  there  are  pairs,  one  on  either  side  of  one  of  the 
principal  meridians,  which  are  of  equal  power.  Lenses  made  with  such 
surfaces  are  called  "toric"  on  account  of  the  form.  It  is  a  law  that  all  regu- 
lar, non-spherical  curved  surfaces  have  their  two  principal  meridians  at 
right  angles,  hence,  when  oculists  and  opticians  prescribe  cross-cylinders 
with  axes  not  at  right  angles  they  prove  they  know  nothing  of  optical  laws 
and  that  they  have  misfitted  the  eyes  the  glasses  are  ordered  for. 


Fig.  70  shows  a  toric  surface.  The  curves  II  H  and  I  indicate  the 
meridians  of  minimum  and  maximum  power;  the  intermediate  meridians  in- 
creasing gradually  from  H  to  I  as  described  in  Chapter  IV,  Fig.  42,  with 
the  difference  that  in  this  instance  the  curve  H  is  substituted  for  the  flat 
surface  in  the  other  cut.  There  the  meridian  had  no  power;  here  all  merid- 
ians have  power,  but  at  H  there  is  the  least. 

Suppose  this  surface  has  a  principal  focal  distance  for  the  horizontal 
meridian  of  16  cm.,  the  diameter  of  the  globe  represented  by  that  curve,  and 
the  other  meridian  has  a  principal  focal  distance  of  7  cm.,  which  is  the 
diameter  of  that  circle;  then  all  other  meridians,  in  pairs,  would  refract  rays 
to  planes  at  right  angles  with  the  axis  at  points  between  7  and  16  cm.  be- 
yond the  lens,  forming  a  caustic,  as  was  shown  in  illustrating  spherical 


A  SYSTEM  OF  MATURE  MEDICINE 


aberration  in  Chapter  III,  but  with  the  difference  that  in  this  instance  there 
is  a  cylindrical  effect  which  destroys  the  image-forming  capacity,  because 
there  is  no  place  in  the  caustic  where  there  is  any  approach  to  a  common 
focus  as  there  is  in  spherical  aberration.  Placing  a  slotted  disc  over  a  lens 
made  in  this  form  with  the  slot  on  one  of  the  principal  meridians  will  permit 
an  image  to  be  formed,  because  all  light  is  shut  off  from  the  non-spherical 
meridians ;  but  the  slot  at  any  other  meridian  will  give  no  such  results,  be- 
cause, if  the  slot  is  at  the  45th  meridian,  for  example,  all  light  passing  above 
the  central  line  will  be  refracted  toward  the  vertical  meridian  and  slightly 
toward  the  horizontal,  exhibiting  a  vertical  mark  on  a  screen.  If  the  same 
experiment  be  tried  on  a  cylindrical  -f-  lens  the  mark  will  be  as  long  as 
the  distance  across  the  lens,  because  there  would  be  no  upward  or  down- 
ward refraction  as  there  is  in  the  compound  or  toric  surface. 

Toric  lenses  are  rarely  needed,  but  many  are  prescribed,  and  they  are 
fraudulently  advertised  as  of  special  value,  when,  as  a  matter  of  fact  they 
are  actually  harmful  for  the  reason  that  they  are  made  in  the  meniscus  form, 
one  surface  of  +  lenses  being  deeply  concave  making  it  necessary  to  make 
the  other  surface  more  convex,  as  was  shown  in  the  chapter  on  meniscus 
lenses. 

Suppose  a  lens  is  needed  with  -f-  8.00  power  in  the  vertical  meridian 
and  -f-  9.00  in  the  horizontal.  This  would  need  a  very  strong  sphere  and  a 
comparatively  weak  cylinder.  Made  ordinary  sphere-cylinder  style  it  would 
be  a  -f-  8.00  sphere  combined  with  a  -J-LOO  cylinder,  axis  90,  which  would 
give  the  power  of  the  sphere  at  the  90th  meridian  and  the  power  of  both 
sphere  and  cylinder  at  the  180th  meridian,  with  the  gradual  increase  of 
cylindrical  power  in  all  other  meridians,  which  Nature  takes  Care  of  if  we 
look  after  the  principal  ones.  But,  this  would  give  -|-  8.00  curve  on  one  sur- 
face and  +  1.00  on  the  other,  making  an  awkward  appearing  lens.  To 
obviate  this  and  reduce  the  aberration  to  its  minimum,  we  would  make  the 
spherical  surface  of  one-half  of  the  power  called  for  by  the  horizontal  merid- 
ian, then  make  the  toric  surface  to  finish  the  demands  of  both  meridians. 


Fig.  71,  mm.  scale,  sectional  views  of  the  horizontal  and  vertical  merid- 
ians of  the  same  lens  made  bi-convex  and  meniscus  sphero-toric.  The  cross 
at  the  right  gives  the  power  required  for  each  of  the  two  meridians.  The 
four  sections  H  H  and  V  V  show  how  that  power  is  furnished  by  the  two 
lenses ;  the  power  units  and  the  radius  of  each  surface  in  centimeters  are 
recorded  at  each  surface  of  the  drawings.  The  chromatic  aberration  of 
torics  makes  them  positively  injurious  to  the  eyes  and  the  high  curves  in- 


REFRACTION,  ETC.,  BY  TRI-CURVED  LENSES  83 

crease  the  reflection  until  the  lenses  are  as  conspicuous  as  automobile  head- 
lights. It  is  a  paradox  that  opticians  who  recommend  torics  are  the  same 
chaps  who  advise  the  invisible  bifocals;  but  they  care  nothing  for  consistency 
if  they  can  secure  the  extra  profits  of  both. 

The  bifocal  mentioned  is  not  only  very  expensive  but  it  has  the  chro- 
matic aberration  fault  exaggerated  to  the  limit.  Even  the  optical  houses 
devoted  to  prescription  filling  have  announced  that  they  "will  not  be  re- 
sponsible for  chromatic  aberration  in  the  fused  bifocals." 

These  optical  houses  differentiate  between  the  deep  meniscus  and  bi- 
convex and  bi-concave  lenses  by  calling  them,  respectively,  "toric"  and  "flat" 
lenses. 

The  indexes  of  the  glass  used  for  fused  bifocals  is  said  to  be  1.523  and 
1.60 ;  therefore,  in  filling  a  prescription  for  -f-  2.00  add  +  2.00  for  near  work, 
the  distance  lens  to  be  "flat,"  there  would  be  a  power  of  -f-  1.00  on  each  sur- 
face, and  with  index  1.523,  the  radii  of  these  surfaces  would  be  52.3  cm., 
because  the  principal  focal  distance  of  each  is  100  cm.,  which,  multiplied  by 
the  excess  index,  .523,  gives  the  radius  52.3.  Then,  as  one  of  the  surfaces 
is  used  for  the  insert,  the  portion  devoted  to  near  work  must  have  an  in- 
creased power  by  reason  of  the  higher  index.  Radius  52.3-H-  .60  =  87%  cm., 
or  1.147  diopters.  The  other  surface  of  the  main  lens  furnishes  1.00  diopter 
power  so  the  total  is  2.147.  Subtracting  this  from  4.00,  the  total  reading 
power  wanted,  leaves  1.853  to  be  added  by  the  "buried"  curve;  and  100, 
divided  by  1.853  gives  54.5  cm.  as  the  principal  focal  distance  of  that  dioptric 
power.  This  54.5,  multiplied  by  the  difference  between  the  two  indexes,  .077, 
gives  4.196  cm.  as  the  radius  of  the  buried  curve. 

But  they  are  often  made  "toric"  or  deep  meniscus,  with  a  —  6.00  or  even 
a  —  9.00  base  curve.  The  lens  just  described  made  on  a  —  6.00  base  would 
have  a  -f-  8.00  curve  on  the  opposite  side  to  get  the  desired  -4-  2.00.  Then, 
if  the  insert  be  fused  on  the  --  side  the  radius  of  curvature  of  the  buried 
curve  would  be  found  as  follows :  The  —  6.00  has  a  principal  focal  distance 
of  16%  cm.,  which,  multiplied  by  the  excess  index,  .523,  gives  a  radius  of 
8.716  cm.  This,  divided  by  the  excess  index  of  the  addition,  .60,  gives  a 
principal  focal  distance  of  14.526  cm.,  or  6.8842  diopters,  an  increase  of  the 
-  surface,  hence  to  regain  the  lost  .8842  and  add  -4-  2.00  the  buried  curve 
must  supply  2.8842  diopters,  which,  with  a  focus  of  34.524  multiplied  by  the 
difference  between  the  two  indexes,  .077,  gives  a  radius  of  2.658  cm.  for 
the  buried  curve.  See  C3  A,  Fig.  72. 

If  the  addition  is  to  be  made  in  the  -4-  side  of  the  lens  we  have  the  radius, 
6.537,  divided  by  .60  gives  10.895  cm.,  or  9.178  diopters,  leaving  only  .822  D. 
to  make  the  full  -f  10.00  against  the  -  -  6.00  for  near  work.  This  .822 
divided  into  100  gives  a  principal  focus  of  121.65,  which,  multiplied  by  the 
difference  between  the  two  indexes,  .077,  gives  9.36  cm.  as  the  radius  of  the 
buried  curve.  See  B,  Fig.  72. 

Then  compare  either  A  or  B,  Fig.  72,  with  C,  at  the  right,  where 
the  respective  radii  of  the  two  sides  are  recorded  together  with  the  radius  of 
the  cement  scale  on  the  outside.  This  is  practically  as  "invisible"  as  the 
fused  bifocal,  has  no  chromatic  aberration  and  in  case  the  addition  for  read- 
ing needs  changing  the  main  lens  does  not  have  to  be  thrown  away  as  is 


84 


A  SYSTEM  OF  MATURE  MEDICINE 


the  case  with  the  fused.     This  scale  should  be  made  oval  16  mm.  long,  14 
mm.  high  and  1  mm.  up  from  the  edge  of  the  main  lens. 

I/1 


c' 


R  6.7/6 


p 


B 


In  order  to  make  the  foregoing  more  emphatic  the  following  drawings 
are  given  to  show  that  when  lenses  are  made  ten  times  as  strong  as  those 
illustrated  in  Fig.  72,  the  curves  on  the  bi-coavex  are  only  a  little  greater 
than  for  the  +  2.00  "torics." 


ff.7'6 


Fig.  73  shows  what  the  curves  would  be  for  the  strong  (20.00D)  "toric," 
as  the  radii  are  millimeters  instead  of  centimeters.  As  a  matter  of  fact 
a  toric  of  the  strength  indicated  could  not  be  made,  for  the  figure  shows  the 
actual  size  of  the  lens. 


C' 


Fig.  74  shows  the  bi-convex  as  it  would  appear  in  comparison  with  the 
"toric."  It  could  be  made  and  used  ;  and  it  demonstrates  that  with  the  thin 
scales  added  for  near  work  bifocals  may  be  made  for  the  strongest  lenses 
people  ever  need  without  any  serious  aberration. 

Fig.  75  shows  the  ordinary  meniscus  lens  as  a  possibility  and  that  while 
it  would  be  superior  to  the  "toric"  it  has  some  of  the  fault  complained  of 
hence  it  does  not  compare  at  all  favorably  with  the  bi-convex. 

Compare  the  radii  of  the  main  surfaces  and  of  the  segments  and  it  is 
easy  to  see  that  the  longer  they  are  the  better,  if  the  nearest  possible  flat  sur- 


REFRACTION,  ETC.,  BY  TRI-CURVED  LENSES 


85 


faces  are  desirable ;  and  we  have  shown  why  such  is  the  case. 

Another  form  of  bifocal  is  called  the  one-piece.  It  is  a  meniscus  of  the 
worst  variety,  that  is  with  a  —  6.00  base  curve,  spherical,  large  enough  for 
two  lenses,  with  a  weaker  --  curve  ground  in  the  center,  so  that  a  -f-  sur- 
face ground  on  the  other  side  gives  both  distant  and  near  power.  See 
"A",  Fig.  76,  which  is  prepared  for  an  addition  of  +  3.00.  If  -+-  8.00  be 
ground  on  the  other  surface  the  result  will  be  +  2.00  for  distance  and  + 
5.00  for  near  work. 


c 

A  IF 


C  B  * 

B,  Fig.  76  shows  how  a  --  lens  may  be  made  without  the  thick  edges 
of  the  ordinary  -  -  lens.  It  is  first  ground  bi-convex,  then  the  —  curves 
ground  in  those  surfaces.  This  is  on  the  same  principle  as  the  "lenticular" 
lens,  D,  in  the  cut.  The  opposite  form  of  "lenticular"  lens  is  shown  in 
C.  These  are  only  employed  when  unusually  strong  lenses  are  required. 

Fig.  76,  E  shows  how  lenses  are  constructed  when  it  is  necessary  to 
reduce  chromatic  and  spherical  aberration  to  the  minimum.  The  middle 
piece  is  bi-convex,  of  twice  the  focal  power  wanted,  and  it  is  made  from 
"crown"  glass ;  Then  the  two  outside  pieces,  made  from  "flint"  glass  and 
each  of  one-fourth  the  power  of  the  middle  piece,  aggregating  one-half  its 
power,  are  so  placed  that  they  neutralize  half  of  the  original  refracting  power, 
and,  with  their  double  index  of  dispersion,  neutralize  all  of  its  dispersive 
power.  This  is  called  an  aplanatic  lens.  If  made  from  two  pieces,  the  flint 
being  all  on  one  side,  it  would  be  an  achromatic  lens,  that  is,  the  color 
aberration  would  be  rectified  but  there  would  still  be  spherical  aberration. 

There  are  other  freak  forms  of  lenses,  exploited  with  great  claims  of 
superiority,  such  as  "greater  field  of  vision,"  "making  clearer  images,"  etc., 
all  of  which  is  what  is  popularly  called  "bunk",  because  spectacle  lenses  are 
not  used  for  taking  pictures,  but  for  changing  the  course  of  rays  entering 
the  eyes.  None  but  ignorant  people  are  fooled  by  such  advertisements.  But, 
as  Barnum  said  "there's  a  fool  born  every  minute."  The  manufacturers  of 
freaks  are  getting  the  money  and  the  people  not  only  give  it  up  but  suffer 
for  it. 


86 


A  SYSTEM  OF  MATURE  MEDICINE 


Other  forms  of  lenses  of  several  curvatures  are  the  "split"  and  "per- 
fection" bifocals,  the  "one-piece"  bifocal,  made  for  near  work,  with  a  place 
ground  out  of  the  top  for  distant  vision,  and  other  devices  of  minor  im- 
portance unworthy  of  mention,  because  most  of  them  are  no  longer  used. 


This  cross-eye  case  responded  to  rational  methods  in  a  few  days. 


CHAPTER  X. 

Neutralization  of  Lenses,  Prescription  Writing,  Transposition  and  Analysis. 

The  neutralization  of  lenses  is  a  simple  thing  yet  it  requires  considerable 
care  to  do  it  correctly  even  when  well  informed  in  principles.  The  first  es- 
sential is  to  be  familiar  with  the  following  facts : 

1.  Prisms   refract  rays   toward   their   base   lines,   consequently  objects 
observed  through  a  prism  will  appear  displaced  toward  the  apex.     Rotating 
a  prism  around  the  visual  line,  that  is  a  line  from  the  eye  to  the  object,  will 
move  the  apparent  or  virtual  object  with  its  apex,  thus  it  may  be  carried 
clear  around  a  circle;  but  it  will  not  distort  the  object.     Holding  a  prism 
base-apex  line  vertical,  for  example,  and  moving  it  right  and  left  or  up  and 
down  while  viewing  the  object  will  have  no  apparent  effect. 

2.  Spherical  lenses,  -j-  or  -t-,  when  rotated  as  described  above,  exhibit 
no  effects,  because  the  same  strength  of  prism  is  always  present;  but  mov- 
ing them  across  the  visual  line  or  back  and  forth  along  it,  there  will  always 
be  motion  of  the  virtual  object.     It  will  move  in  the  direction  opposite  to 
your  movement,  if  the  lens  be  -)-  and  in  the  same  direction  you  move  the 
lens  if  it  be  — . 

3.  Cylindrical  lenses  -f-  or  --  distort  objects  when  rotated  around  the 
line;  a  cross,  for  example,  will  take  the  form  of  an  "x"  when  the  lenses  are 
in  certain  positions  where  the  axis  of  the  cylinder  and  the  meridian  at  right 
angles  therewith  are  not  in  positions  corresponding  to  the  actual  positions 
of  the  lines ;  the  -f-  will  distort  against  your  movement  and  the  -  -  with  it. 
Axial  meridians  being  considered.    The  opposite  meridians  will  reverse  these 
effects. 

4.  Compound  lenses  may  be  composed  of  spheres  and  prisms,  or  of 
spheres  and  cylinders,  or  of  spheres,  cylinders  and  prisms,  when  they  will  all 
exhibit  their  peculiarities  and  we  must  be  able  to  distinguish  not  only  the 
presence  of  each  but  the  nature  as  to  -)-  and  —  spheres  and  cylinders. 

Prisms  are  neutralized  by  using  other  prisms,  bases  reversed,  until  one 
is  found  which  stops  all  rotary  motion ;  or,  a  very  good  way  is  to  use  a 
vertical  or  horizontal  line,  placing  the  base-apex  line  of  the  prism  at  right 
angles,  noting  the  displacement  of  the  line  while  passing  the  prism  and  put 
on  such  other  prism  as  will  neutralize  the  displacement.  Thus,  if  the  prism 
to  be  neutralized  is  base  down  the  neutralizing  prism  will  be  base  up;  and 
the  known  power  of  the  neutralizing  prism  tells  the  power  of  the  neutralized 
one;  but  do  not  forget  the  base  is  reversed. 

Spherical  lenses  are  neutralized  by  sphericals  of  the  opposite  nature. 
That  is,  -f-  are  neutralized  by  -  -  and  vice  versa.  In  doing  this  work  the 


88 


A  SYSTEM  OF  MATURE  MEDICINE 


lens  to  be  neutralized  should  be  held  as  far  from  the  observer  as  possible, 
even  to  arm's  length  as  the  work  is  about  complete,  or  the  exact  power  will 
not  be  found.  Then  the  matter  of  getting  the  axial  lines  of  the  two  lenses 
so  that  they  are  one  line  is  important  as  the  slightest  deviation  will  cause 
a  lens  to  cause  object  motion.  I  presume  more  mistakes  are  made  in  this 
particular  than  in  any  other  in  process  of  the  work  of  neutralization. 

Compound  lenses,  if  sphero-cylindrical,  must  be  held  so  that  the  two 
principal  meridians  correspond  to  the  two  lines  of  the  cross ;  then  it  is  proper 
to  neutralize  the  meridian  of  least  motion  first,  with  a  sphere  and  finish 
the  other  one  with  a  cylinder.  Thus,  if  -f  1-00  neutralizes  the  horizontal 
meridian  but  there  is  still  —  motion  to  the  vertical  meridian,  we  know  more 
-(-  will  be  required  to  neutralize  it,  but  a  -f-  cylinder,  axis  horizontal,  must 
be  used  because  the  spherical  lens  which  has  fixed  that  meridian,  must  not 
be  disturbed.  If  -f-  1.00  cylinder,  axis  horizontal,  finishes  .the  neutralization, 
we  have  -j-  1.00  sphere  -f-  1.00  cylinder  axis  horizontal,  hence  the  lens  neu- 
tralized must  be  a  —  1.00  sphere  —  1.00  cylinder  axis  the  same.  Remember 
that  the  axis  is  always  the  same  but  the  signs  of  power  reverse  in  neutraliza- 
tion ;  but  in  transposition  the  axis  always  changes  90  degrees  if  the  sign 
of  cylindrical  power  reverses. 

If  a  compound  lens  combines  a  prism  neutralize  the  prism  with  prisms, 
the  sphere  with  spheres  and  the  cylinder  with  cylinders.  If  either  sphere  or 
cylinder  is  present  alone  neutralize  it  with  another  of  its  class  but  of  opposite 
sign. 

tUO  .  ^6     $0  Fig.  77  is  a  protractor 

,0  for  locating  the  axes  of 

cylindrical  curvatures. 
Sometimes  they  are  in 
oblique  positions  on 
lenses  and  in  order  to 
neutralize  them  the  lens 
has  to  be  held  obliquely 
on  a  vertical-horizontal 
cross  placed  at  some 
distance  from  the  opera- 
tor, and,  when  the  axis 
is  located,  if  an  ink  mark 
is  placed  on  the  edge  of 
the  lens  and  the  lens  laid 
on  the  protractor  it  will 
give  the  meridian.  But 
here  is  another  particular 
point:  If  the  axis  is 
oblique  in  any  position  except  45  and  135  the  protractor  only  gives  the  merid- 
ian on  which  the  axis  will  be  before  the  eye  if  the  up  side  of  the  lens  is  from 
the  eye ;  if  the  down  side  be  placed  from  the  eye  the  axis  will  be  far  from 
correct.  For  example :  a  lens  marked  and  laid  on  the  protractor  shows  the 
axis  to  be  30 ;  turn  the  lens  over  and  the  axis  will  be  found  at  150.  Or  if  at 
60  with  one  side  up  it  will  be  at  120  with  other  side  up.  If  the  same  side  is 


NEUTRALIZATION,  PRESCRIPTION  WRITING,  ETC. 


89 


up  it  makes  no  difference  if  the  lens  is  turned  end  for  end.  If  the  axes  are 
vertical  or  horizontal  it  makes  no  difference  which  side  is  up  or  which  end  is 
toward  the  nose.  These  are  the  two  principal  meridians  and  the  two  sec- 
ondary meridians  of  lenses  and  also  of  the  eyes. 

Prescription  writing  is  of  great  importance,  because,  in  practice,  if  one 
is  not  entirely  familiar  with  it  as  a  physical  and  physiological  proposition  it 
is  a  serious  handicap.  The  physiological  aspect  will  be  considered  in  an- 
other chapter.  Remember  a  spherical  lens  has  equal  focal  power  in  all 
meridians  while  a  cylindrical  lens  has  focal  power  only  on  lines  at  right 
angles  with  the  axial  line,  hence,  referring  to  meridians,  only  on  the  meridian 
at  right  angles  with  the  axis.  It  has  curves  in  all  meridians  except  the 
axial  one;  and  they  refract  rays  to  point  on  the  axial  line,  but  no  two  rays 
refracted  by  the  same  oblique  meridian  curve  will  hit  that  line  at  the  same 
place. 

Fig.  78  shows  a  cylindrical  lens;  lines  1  and 
2  are  oblique  meridians  crossing  the  center;  rays 
approaching  the  surface  parallel  with  the  axis  will 
be  refracted  along  the  lines  R  R  R  R  from  the 
points  O  O  O  O. 

A  prescription  for  a  compound  lens  is  written 
correctly  when  the  signs  are  alike,  as  -j-  1.00  -{-.75 
axis  90 ;  or,  —  1.00  —  2.00  axis  180.  Also  when  the 
signs  differ  and  the  cylinder  is  at  least  twice  as 
strong  as  the  sphere,  as  -+-  1.00  —  2.00  axis  180.  If 
written  -f  2.00  — 1.00  axis  180  it  would  be  wrong 
because  the  lens  is  -f-  in  all  meridians,  as  analysis 
will  show.  The  fact  that  no  cylinder  has  any 
power  on  its  axis  leaves  the  full  power  of  the  +  2.00  at  the  180th. meridian 
and  at  the  opposite  one,  the  90th,  where  the  cylinder  exerts  all  of  its  power 
it  still  leaves  a  -(-  1.00  effect;  therefore  the  prescription  should  be  written 
-f-  1.00  -)-  1.00  axis  90  to  be  in  its  simplest  form  and  such  a  prescription 
would  cost  ten  cents  less  than  when  written  the  other  way. 


Fig.  79,  shows  the  locations  of  the  principal  focal  points  in  Emmetropia, 
Hypermetropia  and  Myopia  with  reference  to  the  retina,  or  posterior  pole; 
Note  that  in  Em.  the  retina  is  at  the  principal  focal  point;  in  Hy.  it  is  in 
front  of  the  principal  focal  point,  and  in  My.  it  is  behind  the  principal  focal 
point.  The  "punctum  remotum"  or  far  point  of  an  eye  is  the  point  with 
which  the  posterior  pole  is  in  conjugate  focus  when  the  eye  is  in  its  "static" 
condition,  that  is  in  its  natural  state,  without  any  use  of  the  accommodation 
or  facilities  for  adjusting  the  crystalline  lens.  The  old  teachings  are  that 
the  far  point  of  an  emmetropic  eye  is  at  infinity  ;  that  of  a  hypermetropic 
eye  is  beyond  infinity  and  that  of  a  myopic  eye  is  nearer  than  infinity. 


90 


A  SYSTEM  OF  MATURE  MEDICINE 


As  a  matter  of  fact  only  the  myopic  eye  has  a  far  point,  because  it  is 
the  only  one  which  will  take  rays  which  start  from  the  posterior  pole  and 
bring  them  to  a  point  on  the  axis  outside  of  the  eye,  while  the  emmetropic 
eye  sends  them  away  parallel  with  the  axis  and  the  hypermetropic  eye  sends 
them  divergent  from  the  axis.  See  Fig.  80.  Transposition  of  prescriptions 
not  only  puts  them  in  proper  form  and  often  saves  money,  but  it  is  abso- 
lutely necessary  in  the  analysis  of  conditions,  not  merely  static,  but  dynamic. 
The  latter  will  be  treated  later;  the  static  is  given  here  in -order  to  present 
the  proposition  in  its  simplest  form. 


Fig.  81  shows  the  position  of  the  focal  points  with  reference  to  the 
retinal  plane,  R,  when  rays  approach  the  cornea,  C,  parallel  with  the 
axis.  The  first  three  are  simple  conditions  in  which  the  refraction  is  spherical 
hence  all  meridians  are  represented  in  one  angle.  The  last  five  are  compound 
conditions  in  which  the  angles  show  the  two  principal  meridians.  When 
we  take  a  prescription  which  reads  -f~  !•  "  "  .50  axis  180,  for  example,  we 
first  draw  a  line  in  the  direction  indicated  by  the  axis  and  Fig.  77.  Thus, 
180  is  a  horizontal  line.  On  it  write  the  sign  and  power  of  the  sphere;  then 
draw  another  line  at  right  angles  with  the  first,  forming  a  cross,  and  on 


NEUTRALIZATION,  PRESCRIPTION  WRITING,  ETC: 


91 


it  write  the  power  of  the  -f-  sphere  less  the  power  of  the  —  cylinder,  in  this 
instance,  -f-  .50.  This  shows  the  effect  of  the  combination  in  the  two  prin- 
cipal meridians.  Then  draw  a  vertical  line,  like  R,  Fig.  81,  and  diagram 
the  condition  as  indicated  by  the  cross.  See  Fig.  82. 


Fig.   82. 


'0V 


To  rewrite  the  prescription,  begin  with  a  sphere  of  the  kind  and  strength 
indicated  on  the  diagram  for  the  meridian  of  least  defect;  in  this  instance 
it  is  -f-  .50,  because  the  points  are  behind  the  retina ;  this  sphere  shortens  the 
focus  of  both  meridians,  bringing  the  90  to  the  line  and  the  180  nearer,  see 
A,  Fig.  83.  Then  give  a  cylinder  of  the  kind  and  power  indicated,  -f-  .50 


Fig.   83. 


in  this  instance,  placing  the  axis  in  front  of  the  meridian  already  corrected 
by  the  sphere ;  this  corrects  the  deficiency  and  both  meridians  focus  on  the 
same  plane;  the  result  is  that  the  combination  of  lens  and  eye  gives  a  focus 
as  if  the  eye  were  truly  emmetropic  as  shown  in  Fig.  79.  The  prescription 
now  reads,  -J-.50+.50  axis  90.  See  B,  Fig.  83. 

If  a  prescription  reads  -f-  1.00  — 1.75  axis  45  we  put  it  on  the  cross  and 
diagram  as  Fig.  84. 


/.PtS 


Fig.   84. 


+  1.06 


Now,  correcting  the  meridian  of  least  defect  will  require  a  —  sphere  .75, 
which  will  drive  the  135th  meridian  back  to  the  retina,  A,  Fig.  85,  but  it 
will  also  push  the  other  meridian  back  .75  so  a  -f-  1.75  cylinder  will  be  re- 
quired to  pull  it  forward  to  the  line,  and  the  prescription  will  read  —  .75  -f- 
1.75  axis  135,  B,  Fig.  85.  The  nature  of  the  error  will  be  found  by  re- 
ferring to  Fig.  81  which  shows  it  to  be  mixed  astigmatism. 

s-nS 


Fig.   85. 


It  may  be  seen  here  that  if  a  slotted  disc  is  placed  before  the  eye  at 


92  A  SYSTEM  OF  MATURE  MEDICINE 

the  135th  meridian  there  is  nothing  but  simple  myopia  to  deal  with  and  if 
placed  before  the  45th  meridian  there  is  nothing  but  simple  hyperopia  to 
measure;  hence  in  fitting  glasses  in  some  cases  we  proceed  in  that  manner 
to  get  approximately  the  correction  for  each  meridian,  then  working  from 
the  cross  we  diagram  the  eye,  put  on  the  combination  indicated  and  work 
on  from  that  until  we  secure  desired  results. 

Sometimes  a  prescription  reads  like  this :  -\-  1.00  —  T*.00  axis  180.  When 
it  is  put  on  the  cross  we  have  -f-  1.00  at  the  180th  meridian  and  nothing  at 
the  90th,  because  the  cylinder  neutralizes  the  sphere  in  that  meridian ;  and 
on  the  diagram  the  90th  meridian  would  have  its  point  at  the  line  "R"  while 
the  other  would  be  behind  it  1.00.  It  is  easy  to  see  that  only  a  -f- 1.00 
axis  90,  a  simple  cylinder,  would  be  needed,  and  the  saving  in  cost  is  50 
per  cent. 

Following  is  the  law  for  transposing  and  analyzing  compound  prescrip- 
tions as  evolved  from  the  foregoing: 

First  meridian,  Power  of  sphere; 

. 
To  put  on  cross 

Second  meridian,  Power  of  sphere  and  cylinder; 


To  rewrite  the 
Prescription 


I  3  4 

Diagram  condition  of  eye  as  indicated  by  cross; 
5 

Correct  meridian  of  least  defect  with   sphere; 
6 

Allow  for  its  effect  on  the  opposite  meridian; 

7 

Finish  with  cylinder,  axis  on  corrected  meridian. 


No  one  who  knows  his  business  will  ever  find  a  cross-cylinder  combina- 
tion, that  is  two  cylinders,  with  axes  not  at  right  angles  to  each  other.  There 
are  isolated  cases  were  cross-cylinders  might  be  used  but  they  would  never 
have  their  axes  in  any  position  except  at  right  angles,  because  of  the  law 
that  toric  surfaces  always  have  their  two  principal  meridians  in  that  relation. 
For  example,  if  one  meridian  of  an  eye  called  for  —  5.00  and  the  opposite 
one  required  -f-  5.00,  a  sphere  cylindrical  prescription  would  read  —  5.00  -f- 
10.00  axis  on  the  meridian  fixed  by  the  sphere ;  a  —  5.00  axis,  say  180,  com- 
bined with  a  -f  5.00  axis  90,  would  do  the  work  a  little  better  than  the  sphero- 
cylindrical  combination;  but  the  expense  would  be  greater.  To  transpose 
a  prescription  written  arbitrarily  thus,  -f-  2.00  axis  45  — 1.50  axis  180,  the 
best  and  surest  way  is  to  neutralize  it,  when  it  will  be  found  that  the  prin- 
cipal meridians  are  not  as  indicated  by  the  axis  given,  but  are  at  the  60th 
and  150th  meridians,  that  a  +  1.00  —  2.50  axis  60  will  neutralize  it,  hence  it 
will  be  duplicated  with  a  — 1.00-f2.50  axis  60. 


CHAPTER  XI. 

« 

Physical  Construction  of  the  Eyes,  Standard  and  Defective. 

Nature  never  fixed  any  units  of  measure,  such  as  a  mile,  quart,  inch, 
"morals,"  or  anything  else.  But  there  are  Natural  standards  in  all  things, 
if  we  can  find  them.  In  our  search  we  are  always  hampered  by  "accepted 
authorities,"  who  are  nearly  always  wrong,  and  by  fanatical,  dogmatic, 
ignorant  hordes  who  revel  in  their  own  superstitions. 

Taking  for  a  standard  an  ideally  proportioned  eye,  based  on  carefully 
made  tests  of  indexes  of  refraction  of  the  media  and  the  actual  measure- 
ments of  corneal  and  lenticular  curves,  there  is  a  length  on  the  antero- 
posterior  axis  of  %0  inches,  or  22.86  millimeters.  The  posterior  curve  of 
the  crystalline  lens,  with  a  radius  of  6  mm.,  has  its  apex  on  the  axis  15.66 
mm.  from  the  posterior  pole  of  the  eye;  the  anterior  curve  of  the  lens,  with 
a  radius  of  10  mm.,  has  its  apex  on  the  axis  3.6  mm.  farther  from  the 
posterior  pole  or  19.26  mm.  from  it.  This  leaves  3.6  more  as  the  distance 
from  the  anterior  curve  to  the  cornea.  Therefore,  to  construct  a  sectional 
eye  we  must  proceed  from  the  posterior  pole  with  a  ray  divergent  from  the 
axis  and  figure  the  effect  of  each  surface  of  the  lens  separately ;  then,  finally, 
we  find  the  required  radius  of  curvature  of  the  cornea  to  render  rays  parallel 
with  the  axis  as  they  leave  the  eye.  The  procedure  is  that  employed  in 
single  curved  surfaces : 

To  make  it  all  clear  to  the  student  we  must  take  the  indexes  of  the 
various  mediums  and  establish  the  first  and  second  principal  focal  points 
of  the  two  surfaces  of  the  lens.  Compared  with  air  the  index  of  the  cornea 
and  aqueous  humor,  considered  as  one,  is  1.3365 ;  that  of  the  vitreous  humor 
is  the  same;  that  of  the  crystalline  lens  is  1.4371.  Compared  with  the 
aqueous  and  vitreous  humors  the  index  of  the  crystalline  humor  is  1.4371 
-7-1.3365  =  1.0752. 


J,  I.  0  7f2 \  f '  =. 


Fig.  86  shows  the  posterior  surface  of  the  crystalline  lens,  radius  6 
mm.,  with  F'  79.787234  mm.,  or  12.532  diopters,  and  F2  85.787234  mm.,  or 
11.645  diopters.  The  first  is  found  by  dividing  the  radius,  6,  by  the  excess 
index,  .0752,  and  the  second  is  found  by  adding  the  radius  to  the  first  prin- 
cipal focal  distance. 


94  A  SYSTEM  OF  MATURE  MEDICINE 


Fig.  87  shows  the  anterior  surface  of  the  lens,  radius  *10  mm.,  with  F' 
132.9787  mm.,  or  7.52  diopters,  and  F2  142.9787  mm.,  or  6.994  diopters. 


Fig.  88  shows  the  lens  as  a  whole,  index  1.0752,  principal  focus  the 
same  on  either  side,  49.87,  or  20.052  diopters.  This  is  found  in  two  ways  : 
First,  by  adding  the  dioptric  power  of  the  two  surfaces,  calculated  separate- 
ly, using  the  first  principal  focal  distance  of  each,  thus,  7.524-12.532  =  20.052  ; 

1  "1  10  A  1  f\ 

second,  by  adding  the  two  radii  as  common  fractions,  thus,—  +  „  —  •  -f  —  =—  - 

6        10       60        60       60 

which,  reduced,  is    —  —     the  denominator  being  the  equivalent  of  the  two 

O.  i  O 

radii  for  use  as  a  piano-curved  lens,  and  this  figure,  divided  by  the  excess 
index,  .0752,  gives  the  principal  focal  distance,  49.87,  which,  divided  into 
1,000,  gives  the  dioptric  value,  20.052  if  the  thickness  of  the  lens  is  dis- 
regarded; but  this  cannot  be  ignored  for  the  reasons  to  follow:  The  optical 
center  of  the  lens,  O. 

6 
is  found  by  adding  the  two  radii  ——and  cutting  out  the  top  figure,  leaving 

—  —  of  the  thickness  of  the  lens  (3.6  mm.)  from  the  weak  side  toward  the 
strong  one  as  the  location  of  O,  ©r  2.25  mm.  from  the  weak  side,  which  is 
the  anterior  surface. 

The  nodal  points  of  the  crystalline  lens  are  located  as  for  bi-convex 
lenses,  viz  :  The  optical  center  distance,  from  either  surface,  multiplied  by  F' 
of  that  surface  and  divided  by  F2,  less  the  distance  from  the  optical  center 
to  the  surface,  gives  the  distance  from  that  surface  to  its  nodal  point.  There- 
fore : 

2.25x132.9787  _  299.202075    =  g  12fin  tQ  N  for 
142.9787  —  2.25  140.7287 

1.35x79.787234  107.7127659  t^~         -x     , 


85.787234-  1.35  84.437234 

Thus,  the  anterior  nodal  point  is  .1240  mm.  in  front  of  O  and  the  posterior 
one  is  .0723  mm.  behind  O. 

Therefore,  in  view  of  the  foregoing  explanation,  we  must  find  the  exact 
power  of  the  lens  according  to  the  rules  given  in  Chapter  VI.  for  bi-convex 
lenses: 

10x1.0752  =  10.752  ^9       ,  .  ,  -^     ,       ,.          ,, 

-  =  142.9787  =  F2  of  anterior  surface.     Deducting  the 

.07D<& 

thickness  of  the  lens,  we  have: 

142.9787—3.6  =  139.3787,  and,  following  the  rule: 

139.3787  x  79.787234  =  11120.64095151 


139.3787  +  85.787234  =  225.165934 


=  49.3886. 


PHYSICAL  CONSTRUCTION  OF  THE  EYES  95 

Adding  the  distance  from  the  posterior  surface  of  the  lens  to  the  posterior 
nodal  point,  we  have : 

49.3886+1.2776  =  50.6662  mm.  principal  focal  distance. 

1000-^50.6662  =  19.737  diopters  of  power. 


Fig.  89,  made  on  a  scale  of  %  centimeter  representing  1  millimeter, 
shows  a  ray  started  from  F'  toward  the  lens  and  divergent  from  the  axis  is 
refracted  at  the  posterior  surface  and  passes  through  the  lens  as  if  it  came 
from  F2,  because,  figuring  according  to  the  laws  of  refraction  by  single 

curved  surfaces,  we  have  :^|^S_orif^=2O.D4  negative  focus. 

In  other  words:  the  first  conjugate  focal  distance,  15.66,  multiplied  by 
the  opposite  principal  focal  distance  of  the  surface,  85.787234,  equals 
1343.428084;  this  divided  by  the  difference  between  the  first  conjugate  focal 
distance,  15.66  and  the  principal  focus  on  the  same  side  of  the  surface, 
79.787234,  which  is  64.127234,  gives  20.94  which  is  a  negative  focus  because 
the  starting  point  is  inside  of  the  principal  focal  distance  on  that  side. 

Adding  to  20.94  the  distance  from  the  posterior  to  the  anterior  surface 
of  the  lens,  3.6,  we  have  24.54  mm.  as  the  first  conjugate  focal  distance 

,  24.54x132.9787          3264.54729       o-,  K(t  .         , 

of  the  anterior  surface,  and :  +  24.84_142.9787  or  11?-4893  =  27.56  negative  focus. 

Or,  the  first  conjugate  focal  distance,  multiplied  by  the  opposite  prin- 
cipal focal  distance  and  divided  by  the  difference  between  the  first  conjugate 
focal  distance  and  the  principal  focal  distance  on  the  same  side,  gives  the 
second  conjugate  focal  distance,  which  is  negative  for  the  same  reason  the 
other  was,  hence  the  ray  passes  away  from  the  anterior  surface  of  the  lens 
as  if  it  came  from  F3. 

Now,  adding  the  distance  from  the  anterior  of  the  lens  to  the  cornea,  3.6 
mm.,  we  have  27.56+3.6  =  31.16  mm.,  which  is  to  be  regarded  as  the  second 
principal  focal  distance  of  the  cornea.  To  find  the  first  principal  focal  dis- 
tance we  apply  the  law  of  single  curved  surfaces  that  the  principal  focal 
distances  are  to  each  other  as  the  indexes  of  refraction  of  the  two  mediums. 
Therefore,  31.16-j-l.3365  =  23.318,  (43.224D),  the  first  principal  focal  dis- 
tance; and  this,  multiplied  by  the  excess  index,  .3365,  gives  7.84  as  the 
radius  of  curvature  of  the  cornea  necessary  to  take  the  ray  away  parallel 
with  the  axis. 

Fig.  90,  scale  %  cm.  equals  1  mm.,  shows  the  sectional  eye  complete. 
At  1  is  the  center  of  curvature  of  the  cornea,  radius  7.84;  at  2  is  the  center 
of  curvature  of  the  anterior  surface  of  the  lens,  radius  10 ;  at  3  is  the  center 
of  curvature  of  the  posterior  surface  of  the  lens,  radius  6 ;  4  is  the  center 
of  curvature  of  the  globe,  which,  beginning  at  the  points  of  junction  of  the 
curves  of  the  cornea  and  posterior  surface  of  the  lens,  requires  a  radius  of 
10.8.  The  scale  on  which  this  cut  is  made  is  the  same  as  for  Fig.  89. 


9G  A  SYSTEM  OF  MATURE  MEDICINE 


It  has  been  shown  in  Fig.  88  how  the  optical  center  of  the  lens  is  located. 
It  was  also  shown  in  previous  chapters  how  optical  centers  change  with 
changes  of  arrangement  of  surfaces.  Here  we  have  a,new  proposition:  One 
single  curved  surface,  the  cornea,  and  one  double  curved  lens,  the  crystal- 
line, for  the  same  general  reason  that  a  cylindrical  surface  combined  with 
a  spherical  one  makes  two  optical  centers  the  eye  combination,  even  without 
astigmatism,  has  two  optical  centers ;  but  there  is  the  exception  in  this  in- 
stance that  the  optical  center  of  the  lens  is  put  out  of  action.  To  locate  the 
optical  center  of  the  combination  we  take  the  distance  of  the  optical  center 
of  the  lens  from  the  cornea,  5.85  and  that  of  the  optical  center  of  the  cornea, 
7.84  and  regarding  them  as  we  did  the  two  radii  of  the  lens  we  add  them, 

5-85 

7.84   t  cutting  out  the  top  figure  we  have  the  fraction — : —  .  which  is  that 

13.69  . 

portion  of  the  distance  from  the  optical  center  of  the  lens  to  the  optical 
center  of  the  cornea  at  which  is  located  the  optical  center  of  the  combina- 
tion. The  difference  between  those  two  points  is  7.84  —  5.85  =  1.99,  and 

784 

of  that  is  1.138,  which  added  'to  the  distance  of  the  optical  center  of  the 


1369 

lens,  5.85,  makes  6.988  mm.  from  the  cornea  to  the  optical  center  of  the 
combination,  marked  O  in  the  cut.  O2  is  the  optical  center  of  the  lens  alone. 

A  ray  starting  from  the  posterior  pole  of  the  eye,  divergent,  would  be 
refracted  as  described  under  Fig.  89,  and,  finally,  the  corneal  refraction  would 
render  it  parallel  with  the  axis  on  leaving  the  dioptric  system. 

Starting  the  ray  from  the  inside,  parallel  with  the  axis,  we  would  have 
first  the  second  principal  focal  power  of  the  posterior  surface  of  the  lens  : 

6  X  1.0752  _._    6.4512  oe  ivoivoo/i  v         r 

Q752     or     OT52      =  85.787234  positive  focus. 

In  other  words  :  the  radius  multiplied  by  the  index  and  divided  by  the 
excess  index  gives  the  second  principal  focal  distance,  from  the  posterior 
surface  of  lens. 

Now,  deducting  the  thickness  of  the  lens,  3.6,  leaves  82.187234  from 
the  anterior  surface  of  the  lens  to  the  point  found.  Then  we  proceed  : 

82.187234x142.9787     ,          11751.0238  ...         , 

°f  =  ^.13o   positive  focus. 


-8M87834+  132.9787  50.7914 

Or,  the  focus  found  multiplied  by  the  opposite  principal  focus  of  the. 


PHYSICAL  CONSTRUCTION  OF  THE  EYES  97 

anterior  surface  of  the  lens  and  divided  by  the  difference  between  the  focus 
found  and  the  principal  focus  on  the  same  side  gives  the  second  focus, 
which  is  positive. 

Deducting  the  distance  from  the  anterior  of  the  lens  to  the  cornea, 
leaves  19.535  as  the  focal  distance  to  be  considered.  Proceeding  as  before, 
except  using  the  principal  focal  distances  of  the  cornea,  we  have : 

19.535x31.16  608.7106  ...          ,         ,      ,.    . 

or  .  — — —  =  16.09   positive   focal  distance. 


—  19.535  +  23.318  3.783 

Or,  the  focal  distance  found  multiplied  by  the  opposite  principal  focal 
distance  and  divided  by  the  difference  between  the  focus  found  and  the 
principal  focal  distance  on  the  same  side  gives  the  second  focal  distance, 
which  is  positive. 

Adding  to  the  focal  distance  from  the  cornea  the  distance  from  the 
cornea  to  the  optical  center  of  the  combination  we  have  16.09  +  6.988  = 
23.078  as  the  principal  focal  distance  of  the  eye  outside.  Deducting  from 
the  total  length  of  the  eye  the  distance  from  the  cornea  to  the  optical  center 
we  have  22.86  —  6.988  =  15.872  as  the  principal  focal  distance  of  the  eye 
inside. 

The  nodal  points  of  the  eye  are  three  in  number  and  they  are  located 
from  the  optical  center  bv  calculation  as  follows: 

The  distance  from  the  cornea  to  the  optical  center  is  6.988  mm.  The 
first  principal  focal  distance  of  the  cornea  is  23.18  mm.,  the  second  principal 
focal  distance  is  30.98  mm.  The  first  principal  focal  distance  of  the  anterior 
surface  of  the  lens  is  132.4787  ;  the  second  principal  focal  distance  is  142.4787. 
The  first  principal  focal  distance  of  the  posterior  surface  of  lens  is  79.787234; 
the  second  principal  focal  distance  is  85.787234. 

Following  the  rule  given  in  Chapter  VI  for  finding  nodal  points  we 
have  for  the  anterior  point  :  The  distance  of  cornea  from  optical  center. 

6.988x23.18  =  161.98184 


30.98-6.988  =  23.992  ' 

The  distance  from  the  anterior  of  lens  to  optical  center  is  3.388,  and  to 

c.     j  .1  -jji  •    A        3.388x132.4787  —  448.8378  .  f 

find  the  middle  point  :        ,        _  =3.215  mm.  from  anterior  of 


lens  to  N. 

The  distance  from  the  posterior  of  lens  to  optical  center  is  .212,  and  to 

r-      ,    ,  ,  .    A       .212  x  79.787234  =  16.91489  , 

find  the  posterior  point:  85.787234  _^12  =  ^5^3  -.197  mm.  from  posterior 
of  lens  to  N. 

This  places  the  anterior  point  .238  mm.  in  front  of  O  ;  the  middle  point 
.173  mm.  in  front  of  O  ;  and  the  posterior  point  .015  mm.  behind  O. 

The  principal  focal  distance  from  the  optical  center  to  the  posterior  pole 
of  the  eye  is  15.872  mm.,  or  63.00  diopters.  The  perfectly  normal  eye  is 
not  only  constructed  according  to  the  proportions  described,  but  the  crystal- 
line lens  is  built  in  layers,  arranged  as  shown  in  "E",  Fig.  76,  except  that  the 
lens  comprises  many  layers,  doubtless  for  the  same  purpose,  that  of  pre- 
venting aberration.  An  eye  may  be  larger  or  smaller  than  the  one  described 
but  so  long  as  it  retains  the  proportions  given  it  will  be  normal,  that  is  the 
retina  will  be  at  the  principal  focal  distance  of  the  dioptric  system.  This 
is  called  "Emmetropia"  meaning  literally  "in-measure-eye."  Departures 
from  normal  proportions  are  all  included  in  the  term  "Ametropia,  the  nega- 


98  A  SYSTEM  OF  MATURE  MEDICINE 

tive  "A"  being  substituted  for  the  positive  "Em."  The  most  common  defects 
are  in  the  forms  of  the  cornea  and  globe.  If  the  radius  of  the  cornea  is  too 
long  or  that  of  the  globe  too  short  the  retina  will  be  in  front  of  the  principal 
focal  point  of  the  system  and  the  condition  is  called  Hypermetropia,  mean- 
ing literally,  "beyond-measure-eye,"  because  a  ray  started  from  the  axis  at 
the  posterior  pole  of  such  an  eye,  would  be  divergent  after  final  refraction 
and  there  would  be  no  focal  point  outside  of  the  eye ;  therefore  the  Hyper- 
metropic  eye  is  a  —  eye.  If  the  radius  of  the  cornea  is  too  short  or  that  of 
the  globe  too  long,  the  retina  will  be  behind  the  principal  focal  point  of  the 
system,  when  the  condition  is  called  "Myopia"  meaning  literally,  "Muscle- 
eye,"  so  called  because  people  so  affected  have  the  habit  of  closing  the  lids 
to  form  a  narrow  slot,  which  improves  vision ;  but  this  habit  must  not  be  re- 
garded as  evidence  of  myopia,  because  hyperopes  with  astigmatism  often  do 
the  same  thing.  If  both  only  knew  it  a  card  with  a  pin-hole  in  it  would 
be  better  because  it  would  only  let  axial  rays  pass  and  vision  would  be  fine. 

Quite  frequently  eyes  are  found  with  toric  corneas,  like  the  surface 
of  the  lens  shown  in  Fig.  70,  so  that  rays  passing  it  are  refracted  as  by  such 
a  lens,  thus  preventing  a  perfect  focus  on  the  retina,  which  is  the  seat  of  the 
Astigmatism,  as  it  is  called,  because  the  word  means  "without  a  point." 
This  does  not  interfere  with  vision  very  much  unless  there  is  a  diopter  or 
more  difference  between  the  two  principal  meridians,  because  the  image- 
forming  power  of  such  a  system  of  63  diopters,  coupled  with  a  delicate  ner- 
vous system  is  not  easily  thwaited  in  that  particular;  but  there  are  other 
features  which  make  it  important  to  be  corrected  to  the  point  of  comfort. 

There  are  five  regular  subdivisions  of  Astigmatism.  If  one  principal 
meridian  is  emmetropic  and  the  other  one  is  hypermetropic,  it  is  called  Simple 
Hypermetropic  Astigmatism.  As  a  matter  of  fact  it  is  compound,  because 
all  meridians,  excepting  the  normal  one,  are  hypermetropic  on  a  gradually 
increasing  scale  to  the  one  of  maximum  error.  This  is  only  a  technical 
point,  however,  for  the  reason  that  the  law:  All  regular,  non-spherical, 
curved  surfaces  have  their  two  principal  meridians  at  right  angles,  takes 
care  of  it  so  that  a  simple  cylindrical  lens  will  correct  all  defective  meridians 
provided  one  meridian  is  normal.  If  one  principal  meridian  is  emmetropic 
and  the  opposite  one  is  myopic,  it  is  called  Simple  Myopic  Astigmatism.  If 
all  meridians  are  hypermetropic,  but  there  are  two  principal  ones  of  mini- 
mum and  maximum  defect,  it  is  called  Compound  Hypermetropic  Astigma- 
tism. If  all  meridians  are  myopic,  but  there  are  two  principal  ones,  of 
minimum  and  maximum  defect,  it  is  called  Compound  Myopic  Astigmatism. 
If  one  principal  meridian  is  myopic  and  the  opposite  one  is  hypermetropic, 
it  is  called  Mixed  Astigmatism.  The  first  two  are  corrected  with  simple 
cylindrical  lenses ;  the  other  three  by  sphero-cylindrical  lenses. 

As  a  reminder  of  the  information  and  skill  required  to  find  and  correct 
errors  of  refraction  attention  is  called  to  the  fact  that  with  a  perfect  dioptric 
system  of  63  units  of  power  the  principal  focal  distance  is  15.872  mm.  from 
the  optical  center;  while  with  one  diopter  of  hyperopia  the  focal  distance  is 
16.129  or  only  .257  mm.  farther;  and  one  diopter  of  myopia  shortens  the 
focus  to  15.625  a  change  of  .247  mm.  The  latter  impairs  vision  consider- 
ably for  distant  objects,  and  the  former  causes  great  disturbances  phy- 


PHYSICAL  CONSTRUCTION  OF  THE  EYES  99 

siologically,  proving  the  keen  sensibility  of  the  nervous  system  more  than 
any  other  one  thing  physical. 

An  approximate  way  to  construct  the  sectional,  eye,  similar  to  Fig.  90, 
is  to  start  from  the  axis  in  the  same  manner,  but  figure  in  diopters :  The 
distance  from  the  posterior  pole  to  the  posterior  surface  of  the  lens  is  15.66 
mm.,  which  calls  for  63.857  diopters  of  which  the  second  principal  focal 
power  of  the  posterior  surface  of  the  lens  pays  11.645,  leaving  52.212  needed; 
this  represents  a  negative  focal  distance  of  19.1526  mm.,  to  which  must  be 
added  the  distance  from  the  posterior  to  the  anterior  surface  of  the  lens, 
making  22.7526  mm.,  calling  for  43.951  diopters,  of  which  the  first  principal 
focal  power  of  the  anterior  surface  of  the  lens  pays  7.52,  leaving  36.431  un- 
paid and  a  negative  focal  distance  of  27.449  mm.,  to  which  must  be  added 
the  distance  from  the  anterior  of  the  lens  to  the  cornea,  3.6  mm.,  making  a 
total  31.049  mm.,  which  represents  the  second  principal  focal  distance  of  the 
cornea;  and  this  divided  by  the  index,  1.3365,  then  multiplied  by  the  excess 
index,  .3365,  gives  the  radius  necessary  for  the  cornea,  7.81739973. 

Or,  starting  parallel  with  the  axis  inside  the  eye,  we  have  first,  the 
second  principal  focal  power  of  the  posterior  of  the  lens,  11.645  diopters, 
with  a  focal  distance  of  85.787234  mm.;  subtracting  the  thickness  of  the  lens 
leaves  82.187234  mm.,  or  12.16  diopters;  adding  the  first  principal  focal 
power  of  the  anterior  surface  of  lens,  7.52,  gives  a  total  power  of  19.68 
diopters,  with  a  focal  distance  of  50.813  mm. ;  subtracting  the  distance  from 
anterior  of  lens  to  cornea,  3.6  gives  47.213  mm.,  or  21.18  diopters ;  adding  the 
first  principal  focal  power  of  the  cornea,  43.224,  we  have  64.40  diopters  with 
15.52  mm.  focus.  Adding  6.988,  the  distance  from  cornea  to  optical  center, 
we  have  22.508  mm.  as  the  outside  principal  focal  distance,  measured  from 
the  optical  center.  Dividing  by  the  principal  focal  distance  inside  the  eye 
15.872,  gives  1.417  as  the  index  of  the  eye  taken  as  a  homogeneous  body. 
Of  course  these  figures  are  not  so  accurate  as  those  made  from  the  single 
surface  method  of  calculation,  but  they  are  given  for  practice  work. 

"Authorities"  have  stated  that  the  line  of  vision  does  not  correspond  to 
the  optical  axis  of  the  eye,  that  it  is  really  a  secondary  axis.  Then  they  make 
"very  schematic"  drawings  to  illustrate  the  angles  alpha  and  gamma,  at- 
tempting to  show  that  the  first  named  is  formed  by  the  "line  of  vision"  and 
the  "major  axis  of  the  corneal  ellipsoid";  the  second  by  the  "line  of  fixation'' 
and  the  optical  axis;  then  they  state  that  the  fovea  centralis  is  .2  mm.  out- 
side of  the  axis  at  the  posterior  pole  of  the  eye.  They  forgot,  or  did  not 
know  that  while  liars  will  figure,  figures  will  not  lie.  We  have  seen  that  the 
principal  focal  distance  of  the  standard  eye  is  15.872  mm.  We  have  seen, 
in  physical  optics,  that  an  object  is  to  its  image,  in  size,  as  the  conjugate 
focal  distances  are  to  each  other.  The  average  pupillary  distance  is  58  mm.; 
therefore  taking  the  usual  working  distance  6000  mm.  and  dividing  it  by 
15.872,  the  principal  focal  distance,  we  have  a  relation  of  378  between  an 
object  at  6000  mm.  and  its  image  on  the  retina.  One  half  of  the  pupillary 
distance  is  29  hence  that  is  to  be  taken  as  the  size  of  the  object  and  29-f-378 
=  .0767  mm.  from  the  optical  axis  at  the  posterior  pole,  or  considerably  less 
than  half  the  distance  claimed  by  them,  making  it  a  matter  of  such  minor 


100 


A  SYSTEM  OF  MATURE  MEDICINE 


importance  that  it  would  not  be  worth  noting  were  it  true,  which  it  is  not, 
being  merely  an  assertion  impossible  of  proof ;'  and  it  shall  be  shown  that 
the  accommodation  necessary  for  6000  mm.  is  accompanied  by  a  proportionate 
amount  of  convergence  to  bring  the  optical  axes,  which  are  the  real  visual 
axes,  into  position  to  see  singly. 

If  the  crystalline  lens  were  absent,  as  it  is  after  'cataract  operation,  or  as 
it  is  sometimes  naturally  aphakic,  the  index  necessary  for  normal  vision  would 
have  to  be  1.52198,  because  the  antero-posterior  length  of  the  eye  22.86  mm. 
would  be  F2  of  the  cornea,  with  its  radius  of  7.84,  which,  deducted  from 
F2  leaves  15.02  as  F1,  and : 

F2-^1  ==  I.     Thus  22.86-^-15.02  =  1.52198,  index. 


Emmetropia 


Hyperopia 


Myopia 


CHAPTER  XII. 

Physics  of  Retinascopy  and  Why  it  Will  Not  Work  Physiologically. 

There  are  a  lot  of  mystery-lovers  in  the  world  and  among  them  is  found 
the  Retinascope  fiend.  There  are  two  classes  of  him :  The  first  class  com- 
prises oculists  who  declare  it  cannot  be  used  successfully  until  after  the 
eyes  have  been  doped  with  atropine  (deadly  night-shade),  and  they  are 
notoriously  unsuccessful  in  fitting  glasses,  treating  eyes  and  in  operating, 
all  because  they  know  so  little  about  physical  laws  and  the  anatomy  and 
physiology  of  the  eyes  that  it  is  not  worth  mentioning.  We  are  able  to 
prove  this  even  on  those  who  have  written  "authoritative"  text-books — we 
prove  it  by  their  books,  compared  with  the  truth.  The  other  class  is  com- 
posed of  a  lot  of  self-styled  "optometrists,"  who  have  spent  a  lot  of  time  and 
money  seeking  legislation  recognizing  them  as  professional  people  when 
they  should  have  spent  it  securing  some  little  knowledge  of  the  work  they 
profess  to  do.  They  are  smarter  ( !)  than  the  oculists,  because  they  do  not 
need  atropine,  they  can  do  the  job  without;  one  subdivision  of  this  class 
even  pretends  to  do  it  "dynamically,"  which  wins  for  them  the  optical 
dunce-cap  easily. 


Fig.  91  shows  an  emmctropic  eye  being  flooded  with  light  .from  the  lamp, 
L  by  way  of  the  plane  mirror,  M,  and  being  directed  toward  the  point  O, 
behind  the  eye,  it  forms  a  spot  on  the  posterior  field  of  the  eye.  Returning, 
from  the  point  F  dotted  lines  1  and  2  show  the  extreme  edges  of  the  beam, 
one-half  being  on  each  side  of  the  axial  line  P  c  O.  The  point  c  where 
that  line  crosses  the  Optic  Axis  is  the  optical  center,  on  which  the  whole 
matter  hinges,  physically.  With  the  mirror  in  position  M  the  entire  pupil 
is  illuminated  and  the  red  reflex  from  the  retina  is  seen.  Tilting  the  mirror 


102 


A  SYSTEM  OF  MATURE  MEDICINE 


to  position  1  will  throw  the  illuminated  field  at  the  retina  downward,  and, 
as  the  beam  represented  by  the  dotted  lines  is  balanced  on  the  center  c, 
throwing  the  point  F  down  will  tilt  the  beam  upward  at  the  outer  end, 
so  that  all  of  that  half  of  the  beam  coming  from  the  side  of  the  axis,  P  c  O, 
marked  1  will  be  moved  upward  and  the  observer  at  P  only  receives  that 
from  the  side  marked  2,  which  also  moves  upward,  hence  he  will  note  an 
apparent  shadow  pass  over  the  pupil  from  above  downward.  As  he  tilts 
the  mirror  back  toward  position  M  the  whole  pupil  will  be  illuminated 
again ;  but  as  he  tilts  it  on  toward  position  2,  thus  raising  the  illuminated 
field  of  the  retina,  the  outer  end  of  the  returning  beam  drops  down  and  he 
only  receives  light  from  the  side  of  the  beam  marked  1,  and  the  shadow 
will  appear  to  pass  from  below  upward.  In  other  words,  the  shadow  moves 
with  the  movement  of  the  mirror.  This  is  always  true  when  a  plane  mirror 
is  used,  so  long  as  the  two  halves  of  the  returning  beam  remain  on  the  same 
side  of  the  line  P  c  O  that  they  were  when  they  left  the  eye.  This 
is  always  the  case  in  Emmetropia,  Hyperopia  and  in  Myopia  when  the  far 
point  is  farther  away  than  the  mirror. 


Fig.  92  is  a  hyperopic  eye  and  the  dotted  lines  1  and  2  show  how  the 
beam  spreads  as  it  leaves  such  eyes.  The  explanation  of  the  emmetropic 
figure  fits  this  one  equally  well  so  far  as  the  movement  of  the  shadow  is 
concerned.  Were  there  nothing  but  physical  conditions  to  deal  with  there 
would  be  a  difference  in  the  result  of  the  procedure  of  applying  lenses.  As 
the  rays  leaving  the  emmetropic  eye  are  parallel  with  the  axis  P  c  O, 
-f-  lenses  would  be  placed  in  front  of  the  eye  until  the  out-coming  rays  were 
focused  at  the  observer;  if  he  is  at  a  distance  of  one-half  meter  and  the  eye 
is  emmetropic,  a  -|-  2.00  will  do  the  work  and  the  shadow  will  disappear, 
because  the  rays  from  the  entire  pupillary  field  are  brought  to  the  peep- 
hole P  in  the  mirror.  If  the  eye  is  hyperopic  1.00  D,  it  would  require  -\- 
3.00  to  do  the  same  work,  because  the  rays  are  divergent  as  they  leave  the 
eye,  instead  of  parallel.  Therefore  the  working  distance  must  be  considered 
in  all  cases.  Working  at  one  meter  the  emmetropic  eye  would  require  only 
-)-  1.00  and  the  hyperopic  would  require  -(-  2.00.  It  follows  that  after 
stopping  the  shadow  in  any  eye  with  lenses  there  is  too  much  -)-  in  the 
combination  of  eye  and  lens  by  the  equivalent  of  the  working  distance. 
Working  at  one-half  meter  and  finding  no  shadow  would  mean  the  eye  is 
myopic  2.00  D.  Working  at  that  distance  and  finding  that  -f-  lenses  less 
than  2.00  D.  stop  the  shadow  would  mean  that  the  eye  is  myopic  the  diff- 


PHYSICS  OF  RETINASCOPY 


103 


erence  between  the  power  of  -\-  2.00  and  the  amount  of  the  +  lens  found; 
thus,  if  a  +  1-00  stops  the  shadow  the  operator  being  in  conjugate  focus 
with  the  retina  must  have  -\-  2.00  over  the  normal  condition  and  if  the  lens 
only  furnished  -(-  1.00  the  eye  must  be  doing  the  rest. 


Fig.  93  shows  an  eye  which  is  myopic  more  than  the  working  distance, 
as  is  indicated  by  the  focal  point  of  the  dotted  lines  1  and  2  between  it 
and  the  mirror.  In  this  instance,  tilting  the  mirror  to  position  1,  throwing 
the  illuminated  field  of  the  retina  down,  will  tilt  the  out-coming  beam  up,  as 
before,  but  with  a  different  result,  because  the  upper  half  of  the  beam  be- 
comes the  lower  half  at  x  and  the  lower  half  becomes  the  upper;  therefore, 
as  the  beam  tilts  up  the  lower  part,  coming  from  the  upper  half  of  the  pupil, 
is  all  that  is  seen  by  the  operator,  so  the  shadow  appears  to  come  from 
below,  or  against  the  motion  of  the  mirror.  Tilting  the  mirror  back  toward 
the  first  position  M  the  entire  pupil  is  illuminated  again,  but  as  it  is  moved 
toward  position  2,  the  luminous  field  of  the  retina  being  raised  the  outer  end 
of  the  beam  is  lowered,  and  at  the  operator's  eye  the  upper  end  of  the  beam 
is  from  the  lower  half  of  the  eye,  and  being  all  he  receives,  the  shadow 
comes  from  above  downward,  the  darkness  being  due  to  the  simple  fact  that 
the  light  from  that  part  of  the  eye  does  not  pass  to  the  operator's  eye.  In 
such  a  case  —  lenses  would  be  used  until  the  shadow  stopped  because  the 
point  x  is  moved  to  the  operator's  position ;  but  even  then  the  eye  is  still 
undercorrected  the  equivalent  of  the  working  distance  for  the  same  reason 
that  the  -f  cases  are  overcorrected  that  amount.  Such  glasses  require  the 
addition  of  --  lenses  equivalent  to  the  working  distance  to  finish  the  case. 


Fig.   94  illustrates  the   concave   mirror   employed   in   emmetropia.     The 
light,  L'  gives  off  rays  a  c  and  b  d,  which  strike  the  mirror  and  are  reflected 


104 


A  SYSTEM  OF  MATURE  MEDICINE 


to  form  L2,  which  becomes  the  source  of  the  illumination  of  the  eye,  and 
a  second  image  would  be  formed  at  O  if  the  light  could  get  there.  With 
the  mirror  in  position  M  the  pupil  is  entirely  illuminated  for  the  observer 
because  the  beam  is  coming  out  between  dotted  lines  1  and  2  from  F,  at 
the  retina.  On  tilting  the  mirror  to  position  1  the  luminous  point  L2  is 
lowered ;  this  raises  the  illuminated  field  of  the  retina,  and,  the  out-coming 
beam  being  hinged  on  the  optical  center  c  its  outer  end  drops  so  the 
observer  only  receives  light  from  the  upper  part  of  the  pupil,  the  shadow 
coming  up  to  meet  the  downward  movement  of  the  mirror.  Reversing  the 
mirror  movement  the  shadow  backs  off  until  the  pupil  is  all  red,  the  tilting 
the  mirror  toward  position  2,  raises  L2,  thus  lowering  the  illuminated  field 
of  the  retina  and  the  outcoming  beam  is  tilted  upward  so  the  operator  only 
receives  light  from  the  lower  half  of  the  eye  and  the  shadow  comes  down 
to  meet  the  upward  movement  of  the  mirror. 

l!       - 


'-I 


Fig  95  is  a  hyperopic  eye,  showing  the  out-coming  beam  spreading  as 
it  leaves  the  eye.  The  explanation  of  the  emmetropic  eye  fits  -this  one  so 
far  as  the  movement  of  the  shadow  is  concerned ;  the  only  difference  is  in 
the  amount  of  power  in  the  lens  required  to  stop  the  movement  of  the 
shadow.  Working  at  one-half  meter  the  emmetrope  would  require  a  -|- 
2.00  and  the  hyperope  enough  more  to  correct  the  hyperopia.  Then,  from 
the  amount  found  in  both  instances  2.00  D.  would  be  deducted  for  the  work- 
ing distance,  leaving  nothing  for  the  emmetrope  and  whatever  there  is  more 
than  -f-  2.00  for  the  hyperope.  If  the  lens  thus  found  is  less  than  -f-  2.00, 
working  distance  one-half  meter,  the  difference  between  the  lens  found 
stopping  the  shadow  and  -f-  2.00  is  myopia. 


Fig.  96  shows  an  eye  which  is  more  myopic  than  the  working  distance, 


PHYSICS  OF  RETINASCOPY  105 


as  is  indicated  by  the  crossing  of  the  out-coming  rays  1  and  2  at  x.  In  this 
instance,  tilting  the  mirror  to  position  1  lowers  L2,  raising  the  illuminated 
field  of  the  retina,  which  lowers  the  outer  end  of  the  out-coming  beam,  and 
as  the  two  halves  have  changed  positions,  lowering  that  end  of  the  beam 
gives  the  observer  rays  from  the  lower  half  of  the  eye  only  and  the  shadow 
goes  down  with  the  mirror.  Reversing  to  position  2  raises  L2,  lowers 
the  illuminated  field  of  the  retina,  which  raises  the  outer  end  of  the  beam 
and  the  observer  receives  light  from  the  lower  half  only,  which  is  the  upper 
half  at  the  eye,  hence  the  shadow  goes  up  with  the  mirror  movement.  Of 
course  -  -  lenses  must  be  used  to  stop  the  shadow  by  moving  the  point  x 
to  the  operator's  position,  and  they  must  be  increased  an  amount  equivalent 
to  the  working  distance  to  give  the  full  correction. 

It  makes  no  difference  what  the  working  distance  is,  the  principles  set 
forth  work  all  the  time.  With  the  plane  mirror  the  shadow  goes  with  the 
operator's  movement  in  hyperopia,  emmetropia  and  myopia  of  less  than  the 
working  distance;  and  it  moves  against  the  mirror  movement  in  myopia 
greater  than  the  working  distance ;  that  is  when  the  far  point  is  between 
the  operator  and  the  patient.  For  convenience  in  putting  on  lenses,  the  half 
meter  distance  would  be  the  most  natural.  With  the  concave  mirror  the 
movements  of  the  shadow  are  the  reverse  of  those  with  the  plane  one. 

As  a  physical  proposition  this  is  as  easy  as  neutralizing  lenses;  but 
few  can  do  that  exactly;  particularly  those  who  pretend  to  be  able  to  fit 
patients  with  the  mirror,  either  hand  or  machine.  As  a  physiological  matter 
it  is  an  impossibility,  both  theoretically  arid  practically,  with  or  without 
atropine ;  because,  to  paralyze  the  nerves  of  accommodation  so  they  could 
not  work  at  least  a  little  under  the  irritation  produced  by  flooding  the  eye 
with  light,  would  result  in  the  death  of  the  patient  in  many  cases;  then  the 
operator  could  never  tell  when  he  had  total  paralysis  and  repeated  tests  of 
patients  believed  to  be  in  a  state  of  total  cycloplegia  proved  the  contrary. 
Without  atropine,  even  presbyopes  have  their  accommodation  stimulated 
by  the  extraordinary  light  from  the  mirror  and  the  retinascopic  "correc- 
tion" is  always  far  from  the  total  amount  of  hyperopia  and  always  entirely 
too  much  in  myopia.  In  all  of  our  experience  of  about  a  quarter  of  a  cen- 
tury, we  have  never  found  a  case  "fitted"  with  a  retinascope  to  have  any- 
thing approaching  the  real  correction  as  found  by  subjective  methods  and 
proved  after  a  long  period  of  time  for  the  nervous  system  to  become  ad- 
justed to  the  new  situation.  Nor  have  we  met,  in  all  this  time,  a  retina- 
scopic "professor"  who  could  demonstrate  the  theory  of  the  proposition 
correctly.  "Eminent"  writers  on  the  subject  have  exposed  themselves  by 
discussing  the  relative  values  of  the  plane  and  concave  mirrors,  the  sizes 
of  the  peep-holes,  the  working  distances  and  even  the  diameters  of  the  mir- 
rors. Nothing  could  be  more  absurd,  as  the  explanation  of  the  principles 
will  prove  readily. 

Retinascopists  are  the  people  who  talk  about  "latent  myopia"  and  ar- 
gue that  if  a  patient  sees  just  as  well  with  a  -j-  1.00  fitted  with  a  retina- 
scope  as  he  does  with  a  -f-  2.50  fitted  by  a  rational  method  it  proves  it  is  as 
good  a  correction.  "  They  do  not  even  suspect  the  existence  of  a  method  of 


106 


A  SYSTEM  OF  MATURE  MEDICINE 


proving  work.    They  are  so  utterly  ignorant  they  do  not  want  to  learn.     So 
mote  it  be.     I  see  their  finish. 

What  I  have  said  about  the  retinascope  as  a  practical  instrument  for 
physiological  purposes  also  applies  to  the  ophthalmometer,  and  all  other 
instruments  and  machines  with  which  it  is  pretended  errors  of  refraction 
can  be  measured  accurately.  The  ophthalmoscope  is  a  valuable  auxiliary  in 
practice;  but  not  as  a  means  of  fitting  glasses.  The  perimeter  has  limited 
uses  in  finding  the  field  of  vision ;  but  it  is  not  worth  its  cost  to  the 
practitioner,  because  it  offers  no  means  of  enlarging  the  field.  When  optical 
houses  advertise  "instruments  of  precision"  with  which  to  measure  eye  de- 
fects they  are  making  false  statements,  which  are  forbidden  by  law. 


Retinascope 


Ophthalmometer 


CHAPTER  XIII. 

Exercises  Involving  the  Principles  of  Physical  Optics. 

1.  Q.     What  is  light? 

A.  Natural  light  is  a  substance  as  is  indicated  by  its  composition  repre- 
sented in  the  spectral  colors.  In  addition  to  its  luminous  properties 
it  exhibits  effects  upon  animal  and  vegetable  life  and  upon  mental 
conditions.  Artificial  light  is  like  other  artificial  propositions — a 
weak  imitation  of  the  Natural,  lacking  many  of  its  essential  qualities. 

2.  Q.     What  is  refraction  of  light? 

A.  Refraction  of  light  is  the  deviation  in  its  course  a  ray  suffers  when 
it  passes,  obliquely,  from  one  transparent  medium  into  another  of 
different  optical  density. 

3.  Q.     What  are  the  factors  involved  in  accomplishing  refraction? 

A.  The  factors  involved  in  the  refraction  of  light  are  the  chemical  com- 
position of  the  transparent  mediums  and  the  mechanical  construction 
of  those  mediums ;  or,  in  other  words,  the  optical  density  of  the 
mediums  and  the  obliquity  of  the  approaching  ray. 

4.  Q.     What  is  meant  by  "optical  density"? 

A.  Optical  density  differs  from  mere  compactness  in  referring  to  the  re- 
sistance offered  by  transparent  mediums  to  the  passage  of  light 
through  them. 

5.  Q.     What  is  an  index  of  refraction? 

A.  An  index  of  refraction  is  the  expres3ion  in  figures  of  thp  relative  op- 
tical density  of  any  medium  compared  with  an  established  standard. 
Or,  index  of  refraction  is  the  quotient  obtained  by  dividing  the  size 
of  the  angle  of  incidence  by  the  size  of  the  angle  of  refraction  when 
a  ray  of  light  passes  obliquely  from  a  vacuum  into  the  substance 
whose  index  is  wanted,  both  these  angles  being  measured  on  straight 
lines  set  square  with  the  perpendicular  to  the  surface  and  measured 
at  equal  distances,  along  the  ray  of  light,  from  the  point  of  refraction. 
Index  of  refraction  is  also  the  quotient  obtained  by  dividing  the 
speed  of  light  in  a  vacuum  by  the  speed  of  light  in  the  substance 
whose  index  is  wanted. 

6.  Q.     What  is  the  index  of  refraction  of  air? 

A.     Air,  compared  with  a  vacuum,  has  the  index  1.000294. 

7.  Q.     What  is  air,  chemically? 

A.     Air  is  a  mixture  of  nitrogen  and  oxygen  in  proportions  of  4  N  to  1  O. 


108  A  SYSTEM  OF  MATURE  MEDICINE 

8.  Q.     What  is  glass,  chemically? 

A.     Glass  belongs  to  the  salts  family,  chemically. 

9.  Q.     What  is  water,  chemically? 

A.     Water  is  hydrogen  mon-oxide,  a  compound. 

10.  Q.     Knowing  the  indexes  of  two  different  mediums  how  would  a  new 

index  be  established  between  them? 

A.  By  dividing  one  into  the  other.  It  is  best  to  divide  the  smaller  in- 
dex into  the  greater,  but  it  works  either  way. 

11.  Q.     When  a  ray  is  refracted  what  else  happens  to  it? 

A.  It  suffers  reflection,  dispersion,  absorption  to  some  extent. 

12.  Q.  What  are  the  four  angles  exhibited  in  connection  with  refraction? 
A.  Angles  of  incidence,  reflection,  refraction,  deviation. 

13.  Q.  What  is  meant  by  positive  and  negative  refraction? 

A.  As  a  ray  enters  a  dense  medium  it  is  broken  out  of  its  course  toward 
a  perpendicular  to  the  surface  at  that  point ;  as  it  passes  from  that 
into  a  rarer  medium  it  is  broken  from  such  a  perpendicular.  The 
first  is  positive  and  the  second  negative  refraction. 

14.  Q.     What  is  their  cause? 

A.  The  cause  of  the  first  is  the  angle  of  approach  and  the  chemical  at- 
traction of  the  denser  medium.  The  cause  of  the  second  is  the  angle 
of  approach  and  the  loss  of  the  chemical  attraction  of  the  dense 
medium. 

15.  Q.     What  are  the  four  methods  of  making  drawings  illustrating  refrac- 

tion by  plane,  parallel  surfaces? 

A.  First,  the  perpendicular-parallel  method ;  second,  the  circle  method ; 
third,  the  chord-arc  method ;  fourth,  the  base-line  method. 

16.  Q.     What  is  the  advantage  of  the  base-line  method  over  the  others? 
A.     It  works  equally  well  with  any  index  of  refraction. 

17.  Q.     Why  is  the  angle  of  deviation  greater  as  a  ray  leaves  the  denser 

medium  than  when  entering  it? 

A.  Because  the  angle  of  refraction  on  entering  the  denser  medium  is 
only  one-third,  or  thereabouts,  less  than  the  angle  of  incidence,  while 
on  leaving  the  dense  medium  the  angle  of  emergence  is  one-half,  or 
thereabouts,  greater  than  the  angle  of  incidence  to  the  second  surface. 

18.  Q.     Of  what  value  are  physical  principles  beyond  their  physical  uses? 
A.     If  we  apply  them  in  the  development  of  our  reasoning  faculties  their 

value  is  inestimable. 

19.  Q.     What  is  the  difference  between  vertical  and  perpendicular? 

A.  Vertical  is  always  straight,  up  and  down ;  perpendicular  may  be  hori- 
zontal, oblique  or  vertical,  because  it  means  at  right  angles  with  an- 
other position. 

20.  O.     What  is  a  parallel? 

A.     It  is  represented  by  two  lines  always  at  the  same  distance  from  each 

other,  as  the  mark  = 
Relating  to  Prisms: — 

21.  Q.     What  is  a  prism? 

A.     A  prism  is  a  transparent  wedge. 


EXERCISES  IN  PHYSICAL  OPTICS  109 

22.  Q.     What  is  the  law  of  prisms? 

A.  There  are  two  of  them :  First,  rays  passing  a  prism  are  always 
broken  toward  the  base  line,  hence  objects  seen  through  prisms  are 
always  apparently  moved  toward  the  apexes.  Second,  the  angle  of 
deviation  of  a  ray  by  a  prism  is  always  in  the  same  ratio  to  the  angle 
of  construction  of  the  prism  that  the  excess  index  of  the  glass  used 
is  to  the  index  of  air,  or  1.00. 

23.  Q.     What  is  the  angle  of  construction  of  a  prism? 

A.     It  is  the  angle  formed  between  the  two  sides  and  the  base. 

24.  Q.     What  is  the  angle  of  deviation  of  a  ray? 

A.  It  is  the  angle  formed  by  the  course  of  the  incident  ray  and  the  back- 
ward prolongation  of  the  emergent  ray. 

25.  Q.     How  may  the  angle  of  deviation  be  found  without  making  a  drawing? 
A.     By  multiplying  the  base  line  of  the  prism  by  the  excess  index  of  re- 
fraction we  get  the  base  line  of  the  angle  of  deviation,  measured  the 
same  distance  from  its  apex  that  the  base  of  the  prism  is  from  its 
apex. 

26.  Q.     How  do  we  locate  the  position  of  the  apex  of  the  angle  of  deviation? 
A.     Take  the  index  of  air  as  the  numerator  of  a  fraction  the  denominator 

of  which  is  the  index  of  the  denser  medium ;  that  fractional  part  of 
the  distance  through  the  prism,  on  the  line  of  incidence,  will  be 
the  apex  of  the  angle  of  deviation. 

27.  Q.     Suppose  you  have  the  angle  of  deviation  wanted  how  would  you 

find  the  angle  of  construction  of  the  prism? 

A.  Divide  the  base  of  the  angle  of  deviation  by  the  excess  index  of  the 
dense  medium. 

28.  Q.     But  if  you  are  not  given  the  base  line,  what  then? 

A.  If  the  angle  be  given  in  degrees,  minutes  and  seconds,  reduce  to  the 
smallest  division,  divide,  and  restore  to  degrees,  minutes  and  seconds. 

29.  Q.     How  are  prisms  numbered? 

A.  In  degrees,  centrads  and  ordinary  units.  The  latter  is  the  best  be- 
cause it  is  numbered  similarly  to  lenses.  A  prism  of  such  an  angle 
of  construction  that  it  will  take  a  ray  approaching  parallel  with  the 
base-line  and  one  centimeter  from  it,  and  break  it  to  the  base  line 
at  one  meter,  is  denominated  a  1.00  prism;  and  any  prism  that  takes 
such  a  ray  and  breaks  it  to  the  base  line  at  any  other  distance  bears 
the  same  relation  to  1.00  that  the  distance  bears  to  one  meter,  or  100 
centimeters.  Thus,  if  a  prism  breaks  such  a  ray  to  a  point  one-half 
meter  distant  it  would  be  a  2.00;  or  if  one  should  break  it  to  a  point 
on  the  base  line  at  two  meters  it  would  be  a  .50.  Or,  if  the  approach- 
ing parallel  ray  is  nearer  or  farther  from  the  base  line  than  one  cen- 
timeter, the  distance  from  the  prism  at  which  the  ray  strikes  the 
base  line  is  first  divided  into  100  to  get  the  power  it  would  have  if 
the  ray  was  one  centimeter  from  the  base  line  on  entering,  then  the 
result  must  be  multiplied  by  the  distance  from  the  base  line  the 
approaching  ray  actually  is.  Thus  if  a  certain  prism  breaks  a  ray, 
approaching  parallel  with  the  base  line,  to  a  point  20  centimeters 
from  the  plane  of  refraction,  that  distance,  divided  into  100,  would 


110  A  SYSTEM  OF  MATURE  MEDICINE 

give  5.00  as  the  power  represented ;  but  if  the  ray  struck  the  prism 
two  centimeters  from  the  base  line  it  would  mean  5.00  X  2  =  10.00 
prism.  Or,  if  it  was  only  half  a  centimeter  from  the  base  line  on 
entering,  it  would  mean  5.00  X  -50  =  2.50  prism. 

30.  Q.     What  is  the  difference  between  the  above  described  method  and  the 

two  others? 

A.  Practically  no  difference  up  to  about  10  degrees,  which  is  the  highest 
power  ever  needed.  The  reason  for  the  difference  then  is  that  in  the 
higher  powers  the  base  line  and  the  arc  of  the  base  of  the  prism  are 
perceptibly  different  in  length  and  degrees  are  measured  by  the  arc. 
The  same  difference  is  found  between  the  centrad,  or  median  line 
measure  and  the  others. 
Relating  to  Single  Curved  Surfaces: — 

31.  Q.     What  is  presented  by  a  single  curved  surface? 

A.  A  multitude  of  angles  presented  to  rays  approaching  parallel  with 
the  axis,  but  at  different  distances  from  it. 

32.  Q.     What  is  the  object  of  this  sort  of  surface? 

A.  It  is  for  the  purpose  of  securing  a  combination  of  prism  effects  which 
will  bring  a  bundle  of  approaching  rays  to  a  common  point  beyond 
that  surface. 

33.  Q.     Does  it  do  this? 

A.  Not  absolutely.  There  is  always,  in  spherical  curves,  a  constant 
shortening  of  the  meeting  points  of  pairs  of  rays  at  equal  distances 
from  the  axis  as  they  are  farther  from  it,  so  that  there  is  no  point 
common  to  all.  This  is  called  spherical  aberration,  and  the  distance 
along  the  axis  from  the  shortest  focal  point  to  the  longest  one  is 
called  the  caustic.  In  lenses  such  as  are  used  for  the  eyes,  how- 
ever, only  small  portions  are  used  at  once  on  account  of  the  size  of 
the  pupil  of  the  eye,  therefore  the  aberration  does  not  interfere  with 
vision. 

34.  Q.     Where  is  the  optical  center  of  a  single  curved  surface? 
A.     It  is  the  center  of  curvature. 

35.  Q.     What  is  its  radius? 

A.     The  distance  from  the  optical  center  to  the  surface. 

36.  Q.     How  many  principal  focal  distances  has  a  single  curved  surface? 
A.     Two;  measured  from  the  surface  the  first  principal   focal   distance 

is  in  the  rare  medium  and  it  bears  the  same  relation  to  the  second 
principal  focal  distance,  in  the  dense  medium,  that  the  index  of  the 
rare  medium  bears  to  the  index  of  the  dense. 

37.  'Q.     How  are  these  points  located? 

A.  The  radius,  divided  by  the  excess  index  of  the  dense  medium  gives 
the  distance  to  the  first  principal  focal  point ;  and  this  distance,  plus 
the  radial  distance  is  the  second  principal  focal  distance.  Or,  the 
radius,  multiplied  by  the  index  of  the  dense  medium  and  the  product 
divided  by  the  excess  index  of  the  dense  medium,  gives  the  second 
principal  focal  distance. 

38.  Q.     Why  are  they  not  the  same  length? 

A.     Because  there  is  greater  deviation  of  rays  approaching  the  surface 


EXERCISES  IN  PHYSICAL  OPTICS  111 

parallel  with  the  axis  in  the  dense  medium  than  there  is  of  those  ap- 
proaching the  surface  parallel  with  the  axis  in  the  rare  medium. 

39.  Q.     Being  given  the  two  principal  focal  distances  what  is  the  proceeding 

to  find  the  radius  of  curvature? 
A.     The  difference  between  them  would  be  the  radius  of  curvature. 

40.  O.     What  are  conjugate  focuses? 

A.  They  are  respectively  the  points  from  which  rays  diverge  and  toward 
which  they  are  converged  by  the  refracting  surface.  The  word  "con- 
jugate" means  "yoked  together."  The  point  where  an  object  is  located 
is  the  first  conjugate  focal  point  and  the  point  where  the  image  is 
formed  is  the  second  conjugate  focal  point. 

41.  Q.     An  object  placed  100  cm.  outside  of  a  single,  convex  curved  surface, 

having  an  index  of  1.50  and  a  radius  of  20  cm.,  at  what  distance  in- 
side the  dense- medium  will  the  image  be  formed? 

A.  The  first  thing  to  do  is  to  find  the  outside  principal  focal  distance : 
Radius,  20,  divided  by  the  excess  index,  .50,  gives  40  cm.  as  the 
principal  focal  distance.  Then  100X60-^(100— 40)60  =  100,  the 
second  conjugate  focal  distance. 

42.  Q.     Being  given  two  conjugate  focal  distances  and  the  radius  of  curva- 

ture of  a  single  curved  surface,  what  is  the  proceeding  to  find  the 
index  of  refraction? 

A       u  (C'+R)  x  C1 

A.     Formula :    ,~ ~    ' — 7^-  =  Index. 

(,C  — K.)  x  (^ 

43.  Q.     Index  1.52;  radius  20  cm.;  find  first  principal  focal  distance? 

A.  Radius,  20,  divided  by  excess  index,  .52,  gives  38.4615  as  the  first 
principal  focal  distance. 

44.  Q.     Index  1.53;  radius,  30  cm.;  find  second  principal  focal  distance? 

A.  Radius,  30,  multiplied  by  the  index,  1.53  and  divided  by  the  excess 
index,  .53,  gives  86.6  as  the  second  principal  focal  distance. 

45.  Q.     Index  1.53;  first  principal  focal  distance  9  cm.;  what  is  the  radius? 
A.     Given  focal  distance,  9,  multiplied  by  the  excess  index,  .53  gives  4.77. 

cm.  as  the  radius. 

46.  Q.     Radius  24  cm.;  first  principal  focal  distance  52;  what  is  the  index? 
A.     Radius,  24,  divided  by  the  first  principal  focal  distance,  52,  gives  .4615 

as  the  excess  index,  to  which  add  1.00,  making  1.4615,  index. 

47.  Q.     Radius,  20  cm.;  second  principal  focal  distance  60  cm.;  find  index? 
A.     Second  principal  focal  distance,  less  the  radius  gives  40  cm.  as  the 

first  principal  focal  distance,  which,  divided  into  the  second  princi- 
pal focal  distance,  gives  the  index,  1.50. 

48.  Q.     Index  1.53;  radius,  15  cm.;  image  80  cm.;  what  is  object  distance? 
A.     Radius,  15,  divided  by  the  excess  index,  .53,  gives  the  first  principal 

focal  distance,  28.3 ;  adding  the  radius  gives  the  second  principal  fo- 
cal distance;  then,  if  the  image  is  in  the  dense  medium,  multiply  its 
distance,  80,  by  the  first  principal  focal  distance,  28.3,  which  gives 
226.4,  and  divide  by  the  difference  between  the  image  distance,  80 
and  the  principal  focal  distance  on  that  side,  43.3,  which  is  36.7,  and 
the  result  is  61.68,  the  object  distance  from  the  surface. 

49.  Q.     Index  1.54;  second  principal  focal  distance,  24;  find  first  principal 

focus? 


112  A  SYSTEM  OF  MATURE  MEDICINE 

A.  The  given  distance,  24,  divided  by  the  index,  1.54,  gives  15.5844  as 
the  first  principal  focal  distance. 

50.  Q.     Under  what  circumstances  do  the  first  and  second  principal  focal  dis- 

tances reverse  their  relationship? 

A.  When  they  are  measured  from  the  optical  center  instead  of  the 
surface? 

51.  Q.     What  are  the  relative  sizes  of  objects  and  images   formed  by  re- 

fraction through  a  single  curved  surface? 

A.  They  are  in  the  same  ratio  the  two  conjugate  focal  distances  are 
to  each  other,  measured  from  the  optical  center. 

52.  Q.     The  dense  medium  presents  a  concave  surface  with  a  radius  of  20 

cm. ;  Rays  approaching  parallel  with  the  axis  will  be  focused  by  re- 
flection where? 
A.     At  one-half  the  radius  of  curvature,  or  10  cm. 

53.  Q.     An  object  is  placed  100  cm.  from  above  surface;  where  will  its  image 

be  formed? 

A.  The  first  conjugate  focal  distance,  100,  multiplied  by  the  principal 
focal  distance,  10,  and  divided  by  the  difference  between  them,  90, 
gives  11%  cm.  as  the  second  conjugate  focal  distance  by  reflection. 

54.  Q.     Radius,  10  cm. ;  index,  1.52 ;  what  is  the  prism  value  4  mm.  from  the 

axis? 

A.  Radius,  10  cm.,  divided  by  the  excess  index,  .52,  gives  19.269  as  the 
first  principal  focal  distance,  which,  divided  into  100,  the  standard 
of  measure,  gives  5.184  units  if  the  rays  are  parallel  in  the  dense 
medium  1  cm.  from  the  axis,  or  base  line;  but  as  this  one  is  only  4 
mm.  or  %o  cm.  from  the  axis  it  follows  that  it  is  only  four-tenths  of 
5.184  units  prism  effect,  or  5. 184X-4  =  2.0736  units  prism  power. 
If  the  rays  approach  parallel  with  the  axis  in  the  rare  medium  the 
prism  effect  is  weaker.  To  find  the  units  divide  the  last  figure  by  the 
index,  1.52,  which  gives  1.3642  as  the  prism  units  effect  on  rays  en- 
tering the  denser  medium  at  that  distance  from  the  axis. 
Relating  to  Lenses: — 

55.  Q.     Principal   focal  distance  50  cm. ;  index  1.52 ;  what  are  the  radii  of 

four  lenses,  made  plano-convex,  bi-convex,  standard   meniscus   and 
"toric,"  (deep  meniscus),  with  base  curve  —  6.00? 

A.  For  plano-convex,  the  principal  focal  distance,  50  cm.,  multiplied  by 
the  excess  index,  .52,  gives  the  radius,  26.  For  a  bi-convex  of  the 
same  power,  the  radius  of  each  surface  will  be  double  that  for  the 
plano-convex.  For  the  standard  meniscus,  which  has  a  base  curve 
of  -  -  1.25,  hence  a  principal  focal  distance  of  80  cm.,  the  radius  of 
the  —  surface  would  be  80X-52  =  41.6  cm. ;  the  other  side  would  have 
to  be  1.25  stronger  than  the  plano-convex,  which  is  -4-  2.00  in  order 
to  make  up  for  the  negative  surface ;  hence  2.00-J-1.25  =  3.25,  with 
a  principal  focal  distance  of  30.769  cm.,  which,  multiplied  by  the  ex- 
cess index,  .52,  gives  15.999  cm.  radius  of  -4-  curve.  For  the  deep 
meniscus,  the  —  6.00  surface  with  a  principal  focal  distance  of  16% 
cm.,  multiplied  by  the  excess  index,  .52,  gives  8.66%  cm.,  radius ;  to 
get  a  total  power  of  +  2.00  the  other  surface  would  have  to  be  -4-  8.00, 


EXERCISES  IN  PHYSICAL  OPTICS  113 

with  a  principal  focal  distance  of  12.5  cm.,  multiplied  by  .52  gives 
6.5  cm.  radius. 

56.  Q.     With  a  principal  focal  distance  of  45  cm.,  and  a  radius  of  22.5  cm., 

what  is  the  index? 

A.  Radius,  22.5,  divided  by  45,  gives  the  excess  index,  .50,  to  which  add 
1.00,  making  total  index  1.50. 

57.  Q.     Principal  focal  distance,  50  cm. ;  first  conjugate  focal  distance  150 

cm.,  what  is  the  second  conjugate  focal  distance? 

A.  The  first  conjugate  focal  distance,  150,  multiplied  by  the  principal 
focal  distance  and  divided  by  the  difference  between  them,  gives  75 
cm.  as  the  second  conjugate  focal  distance. 

58.  Q.     First  conjugate  focal  distance  100  cm. ;  second  conjugate  focal  dis- 

tance, 200  cm.;  what  is  the  principal  focal  distance? 

A.  Multiply  the  two  conjugate  focal  distances  together  and  divide  by 
their  sum;  thus,  100X200  =  20,000-f-(100+200) 300  =  66%.  Or,  the 
first  conjugate  focal  distance,  100,  equals  1.00  diopter;  the  second 
conjugate  focal  distance,  200,  equals  .50  diopter;  the  two  added,  equal 
1.50  which  has  a  principal  focal  distance  of  66%. 

59.  Q.     Radius  20  cm.;  index  1.52;  first  conjugate  focal  distance  100  cm.; 

what  is  the  second  conjugate  focal  distance? 

A.  Radius,  20,  divided  by  the  excess  index,  gives  the  principal  focal  dis- 
tance, 38.46  cm.  This,  multiplied  by  the  first  conjugate  focal  dis- 
tance and  divided  by  the  difference  between  the  two  figures,  will  give 
the  second  conjugate  focal  distance  62.49  cm. 

60.  Q.     First  conjugate  focal  distance,  100  cm.;  second  conjugate  focal  dis- 

tance, 50  cm.;  index,  1.52;  what  is  the  radius? 

A.  Multiply  the  given  distances  together  and  divide  by  their  sum  to  get 
the  principal  focal  distance ;  then  multiply  it  by  the  excess  index  to 
get  the  radius.  Thus, 

100X50  ==  5,000^(100+50)150  =  33%X-52  =  17.33% 
Or,  convert  both  conjugate  focal  distances  to  diopters,  add  them,  find 
principal  focal  distance  and  multiply  by  excess  index  to  get  radius. 

61.  Q.     First  conjugate  focal  distance,  120  cm.  is  shifted  to  80  cm.  and  the 

change  in  first  conjugate  position  causes  the  second  conjugate  point 
to  be  three  times  farther  than  when  object  was  in  first  position;  what 
are  to  two  second  conjugate  focal  distances  and  what  is  the  power 
of  the  lens? 

A.  The  first  conjugate  focal  distance,  120  cm.,  represents  .83%  diopters; 
the  second  position,  80  cm.,  represents  1.25  diopters;  the  difference 
between  them  is  .41%  diopters,  which  represents  a  principal  focal 
distance  of  240  cm.,  but  as  this  is  a  change  in  first  conjugate  focal 
distance  and  a  special  effect  is  designated  in  the  question,  we  mul- 
tiply the  240  by  the  times  farther  specified  as  the  change  in  second 
conjugate  focal  distance,  which  is  3;  therefore,  240X3  =  720  cm.  as 
the  second  conjugate  focal  distance  in  relation  with  the  second  object 
position,  80  cm. ;  and  the  power  of  the  lens  is  the  equivalent  of  80,  or 
1.25  -f  the  equivalent  of  720  or  .1388  a  total  of  +  1.3888  diopters. 
The  second  conjugate  focal  distance  found  to  be  720  cm.  is  three 


A  SYSTEM  OF  MATURE  MEDICINE 


times  farther  than  the  second  conjugate  focal  distance  for  the  first 
object  position,  must  be  four  times  as  far;  hence,  720-J-4  =  180  cm. 
as  the  first  second  conjugate  focal  distance ;  this  is  .555  diopters, 
which,  added  to  the  original  position,  120,  expressed  in  diopters,  or 
•83%  gives  .83%-f  .555  =  1.3888  diopters,  power  of  lens. 

62.  Q.     First  conjugate  focal  distance,  60  cm.,  shifted  to  100  cm.,  changes  the 

second  conjugate  focal  distance  to  one  fourth  as  far  from  the  lens  as 
when  object  is  in  first  position;  what  are  the  two  second  conjugate 
focal  distances  and  what  is  the  power  of 'the  lens? 

A.  This  is  like  the  other,  only  reversed.  The  two  distances  given  repre- 
sent respectively  1.66%  and  1.00  diopter.  Their  difference  is  .66% 
diopters  with  a  principal  focal  distance  of  150  represented.  This 
multiplied  by  %,  (because  that  is  the  portion  of  conjugate  focal  dis- 
tance lost  by  the  change  of  object  position),  gives  112.5  or  .8888  D. 
as  the  second  conjugate  focal  distance  associated  with  the  second 
position  of  object;  therefore  the  lens  is  1.00-)-. 8888  or  1.8888  diopters. 
As  the  second  conjugate  focal  position  found  is  only  one-fourth  as 
far  from  the  lens  as  the  original  second  position,  it  must  be  four 
times  the  one  found;  hence  112.5X4  =  450,  or  .2222  D. ;  and  this 
added  to  the  diopters  of  the  original  position  of  object,  1.66%  gives 
1.8888  diopters  power  of  lens,  as  before. 

63.  O.     What  is  the  principal  focal  distance  of  a  lens,  bi-convex,  having  radii 

8  and  5  cm.  and  an  index  of  1.54? 

A.  Multiply  the  two  radii  together  and  divide  by  their  sum,  after  first 
multiplying  it  by  the  excess  index.  Thus, 

8X5  =40-;- ( 13 X- 54) 7.02  =  5-698  =  P  F. 

Or,  considered  as  two  piano-curved  lenses,  the  radius,  8,  divided  by 
excess  index,  .54,  gives  14.8185  cm.  focus,  or  6.748  D. ;  radius  5, 
divided  by  .54  gives  9.26  focus,  or  10.799  D.  Adding  the  two  gives 
17.547  D.  with  a  principal  focal  distance  of  5.698  cm. 

64.  Q.     What  is  the  principal  focal  distance  of  a  lens  with  two  radii,  one 

—  8  and  the  other  -f-  4  cm.;  index  1.60? 

A.  This  is  worked  in  the  same  manner  as  A.  62,  except  that  the  sum  of 
the  radii  in  this  instance  is  the  difference  between  them,  as  one  is 

—  and  the  other  -4- : 

4X8  =  32-K8— 4  =  4X- 60)2.40  =  13%   P.   F. 

65.  Q.     What  is  the  index  of  a  lens  having  radii  -j-  6  —  12  cm. ;  principal 

focal  distance  24  cm.? 

A.  By  the  fraction  method  % — Vi2  =  Viz,  and  12  divided  by  the  prin- 
cipal focal  distance,  24,  gives  the  excess  index,  .50,  to  which  add 
1.00. 

66.  Q.     An  object  is  100  cm.  from  a  —  5.00  D.  bicurved  lens  of  equal  radii ; 

what  is  the  character  of  the  image  and  where  is  it? 

A.  The  image  will  be  formed  by  reflection  from  the  first  surface,  — 2.50; 
the  principal  focal  distance  by  reflection  is  always  one  half  of  the 
radial  distance.  As  no  index  is  given  we  will  assume  it  to  be  1.52; 
hence  as  2.50  D.  represents  40  cm.  focus,  we  multiply  40  by  .52  to 
get  the  radius,  which  is  20.8  cm  :  and  half  of  this  is  10.4  cm.  the 


EXERCISES  IN  PHYSICAL  OPTICS  115 

principal  focal  distance.     This  multiplied  by  the  first  conjugate  focal 
distance,   100,   and   divided   by  the   difference  between  them   gives : 
10.4X100  =  1040-^89.6  =  11.607  cm.  =  Cf2 

67.  O.     A  +2.00  lens  is  placed  10  cm.  in  front  of  a  +2.50;  what  is  the  power 

of  the  combination? 

A.  The  -4-  2.00  starts  the  rays  toward  a  focus  50  cm.  from  it ;  -f-  2.50  at 
10  cm.,  receives  the  rays  on  their  way  to  a  focus  40  cm.  beyond  it, 
which  equal  2.50,  adding  2.50  makes  a  total  of  5.00  D.  with  a  focal 
length  of  20  cm. ;  adding  the  10  cm.  between  lenses  we  have  30  cm. 
as  the  focal  length  of  the  combination,  which  equals  a  dioptric  power 
of  3.331/0. 

68.  Q.     A  lens  is  -4-  2.00;  radius  of  one  side  is  —  40  cm.;  index  1.53;  what  is 

the  radius  of  the  -4-  side? 

A.  The  radius  of  the  —  side,  40,  divided  by  the  excess  index,  .53,  gives 
75.47  cm.  focal  distance,  or  1.32  D.  To  get  the  -+-  2.00  effect,  the 
other  side  must  be  a  -4-  3.32  D.  with  a  focal  length  of  30.2  cm.,  and 
this,  multiplied  by  the  excess  index,  .53,  gives  the  radius,  15.96  cm. 

69.  Q.     A.  -4-  lens  has  a  principal  focal  distance  of  50  cm. ;  the  radius  of  one 

surface  is  15  cm.;  index,  1.54;  what  is  the  radius  of  the  curve  on  the 
other  surface? 

A.  The  given  radius,  15,  divided  by  the  excess  index,  .54,  gives  27.77  cm. 
as  the  principal  focal  length,  or  3.60  D.  which  is  1.60  D.  more  than 
is  wanted;  hence  the  other  curve  must  be  -••  with  1.60  power.  Its 
focal  distance,  62.5,  multiplied  by  the  excess  index,  .54,  gives  33.75  as 
the  radius  of  the  —  surface  curve. 

70.  Q.     The  radii  of  a  lens  are  -4-  8  and  —  6  cm. ;  the  focal  distance  is  50  cm.; 

what  kind  of  a  focus  is  it  and  what  is  the  index? 

A.  It  is  a  —  lens,  because  the  —  radius  is  the  shortest.  By  the  fraction 
method,  % — %  is  .equal  to  %s — %8  =%8  or  %4  ;  and  24,  the  new 
radius,  divided  by  the  focus,  50,  gives  .48  excess  index,  to  which 
add  1.00,  making  index  1.48. 

71.  Q.     What  are  the  cardinal  points  and  planes  of  a  lens? 

A.  They  are  the  principal  points  and  planes,  nodal  points  and  planes, 
optical  center  and  its  plane,  principal  focal  points  and  planes. 

72.  Q.     AYhat  are  the  four  essentials  of  a  perfect  dioptric  system? 
A.     Transparency,  density,  symmetry  and  adjustability. 

73.  Q.     How  are  the  optical  centers  of  lenses  found  by  calculation? 

A.  If  it  be  a  bi-convex  or  bi-concave  lens  the  sum  of  the  two  radii  is 
taken  as  the  denominator  of  a  fraction,  the  numerator  of  which  is 
one  of  the  radii ;  the  entire  fraction  represents  that  portion  of  the 
thickness  of  the  lens,  from  the  side  represented  by  the  numerator, 
to  the  optical  center.  If  it  be  a  plano-convex  or  plano-concave  lens, 
there  being  but  one  radius,  the  numerator  and  denominator  of  the 
fraction  will  be  the  same,  as  %  or  1(%0,  therefore  the  optical  center 
will  be  the  thickness  of  the  lens  from  the  flat  side,  or  at  the  apex  of 
the  curved  surface.  If  the  lens  be  a  meniscus,  -4-  or  — ,  the  short 
radius,  multiplied  by  the  lens  thickness  and  the  product  divided  by 
(the  difference  between  the  radii  multiplied  by  the  index)  -  -  half 


116  A  SYSTEM  OF  MATURE  MEDICINE 

the   thickness   of  the   lens;   thus;  with   radii    -|-   20   and    -      40   lens 
4    points     thick:    20X4  =  SO-:-(+20— 40  =  —£0X1.50  =  30+2)33  = 
2%  points  outside  the  curve  of  shortest  radius. 

74.  Q.     At  what  distance  from  any  spherical  lens  must  an  object  be  placed 

to   have  the  image  formed  at  exactly  the   same  distance   from   the 
lens? 
A.     At  twice  the  principal  focal  distance. 

75.  O.     A  bi-convex  lens  has  its  optical  center  one-fourth  of  the  thickness  of 

the  lens  from  one  surface ;  what  is  the  ratio  of  the  two  radii  ? 
A.     As  1  is  to  3. 

76.  Q.     The  principal  focal  distance  of  the  standard  normal   eye  is   15.872 

mm.  from  the  optical  center;  how  many  units  power  is  represented? 
A.     Sixty-three. 

77.  O.     The  radius  of  the  cornea  is  7.8  mm.;  index  1.3365;  what  is  the  first 

principal  focal  distance. 
A.     The  radius,  divided  by  the  excess  index,  gives  23.17979  mm. 

78.  Q.     An  eye  is  myopic  1.00  unit,  how  much  will  shorten  the  principal 

focal  distance? 
A.     A  trifle  less  than  a  quarter  of  a  millimeter :  .247,  to  be  exact. 

79.  Q.     An  eye  is  hyperopic  1.00  unit;  how  much  will  it  lengthen  the  prin- 

cipal focal  distance? 
A.     A  trifle  more  than  a  quarter  of  a  millimeter ;  .257,  to  be  exact. 

80.  O.     What  would  be  the  principal  focal  distance  of  the  crystalline  lens 

in  air? 

A.  The  two  radii  6  and  10  mm.  being  added,  %+Mo  or  1%o+%o  =1%o'. 
reduced,  gives  ^-75  as  the  radius  of  a  piano  convex  lens  of  same 
power;  and  3. 75-f-.4371  =  8.57927+  as  principal  focal  distance. 

81.  Q.     What  are  axial,  corneal,  lenticular,  polar  errors  in  the  eyes? 

A.  Axial  is  when  the  eyes  are  too  long  on  the  axis  to  fit  the  principal 
focal  distance.  Corneal  is  when  the  fault  is  in  the  cornea ;  lenticular, 
when  it  is  in  the  lens;  polar  when  it  is  in  the  posterior  form  of  the 
globe. 

82.  Q.     What  difference  is  there  in  the  correction  of  these? 

A.  None  whatever.  It  is  impossible  to  differentiate  any  except  the 
corneal  deformity. 


Part  II 
OPHTHALMOLOGY 


CONTENTS,  PART  II. 

THIRTY-THREE    ILLUSTRATIONS. 

NIV.     Anatomy  and  Physiology  of  the  Nervous  System 119 

XV.     Anatomy  and  Physiology  of  the  Eyes  and  Their  Appendages.  .127 

XVI.     Physiology  of  the  Eyes  Utilized  to  Measure  Nerve  Supply  and 

Demand    135 

XVII.     Errors  of  Refraction  in  the  Dioptric  System — How  They  are 

Compensated  for  by  Accommodation  and  with  Lenses..  143 

XVIII.     The    Neurometric    Method   of  Analysis    of    Conditions    Found 

By   Examinations    155 

XIX.     Cyclophoria  Often  the  Cause  of  Apparent  Oblique  Astigmatism  171 
XX.     Physiological  Action  of  Prisms  with  Proofs  of  Their  Unvalue  175 

XXI.     Heterophoria,    "Muscular   Insufficiency,"    a    Nervous    Exhibit. 

Treatment     181 

XXII.     Heterotropia,  Strabismus,  Squint,  Cross-Eyes.    Treatment  for  185 

XXIII.  Alleged  "Diseases"  of  the  Eyes.  Their  Causes  and  Treatment.  .189 

XXIV.  Objective  and  Subjective  Methods  Employed  in  Eye  Testing.  .205 

XXV.     Situation   in    Emmetropia,   Hyperopia   and    Myopia,    with    the 

Lens  Removed 217 

XXVI.     Seeing,  Hearing,  Smelling,  Tasting,  Matters  of  Education.  ..  .219 

XXVII.     Fitting  Spectacle  Frames  an  Important  Matter 223 

XXVIII.     General  Disorders,  Symptoms  of  Which  are  Called  "Diseases"  225 

XXIX.     Human  Ills  and  Their  Causes  Viewed  From  a  Rational  Stand- 
point      241 

XXX.     The  Color  Sense.     Color  Ignorance.     Theories  of  Color-Blind- 


ness 


XXXI.     Physiognomy  and  Craniology  .Indicate  Temperament  and  Dis- 
position     261 

XXXII.     Some  of  the  Idiosyncrasies  of  "Eminent"  Authors 265 

XXXIII.     Idiosyncrasies  which  Exhibit  in  People  of  Various  Professions 

and  Trades   271 

Appendix    279 

Eponymes — Ophthalmology 299 

Glossary    305 

Prefixes  and  Suffixes 311 

Abbreviations — Ophthalmology     311 

Special   Subject   Index    312 

Index     313 

List  of  Illustrations    .  .  .318 


CHAPTER  XIV. 
Anatomy  and  Physiology  of  the  Nervous  System. 

To  the  Ophthalmologist  and  Neurologist  the  Nervous  System  is  Life. 
All  else  is  subordinate  and  auxiliary  to  it.  All  human  ills  are  exhibited 
through  and  by  it.  All  pains  and  fevers  are  nervous  symptoms.  They  are 
the  two  best  friends  of  humanity  generally  and  of  the  doctors  in  particular. 
The  doctor  who  administers  drugs  to  allay  pain  is  a  criminal  and  the  person 
who  takes  the  dope  is  foolish. 

The  old-school  vocabulary  is  replete  with  such  words  as  "myalgia" 
(muscle  pain).  There  is  no  such  thing.  All  pains  are  nerve  pains,  hence  are 
"neuralgia."  The  nervous  system  is  the  only  thing  capable  of  exhibiting 
sensation.  Motion  may  be  developed  artificially,  but  the  sensations  are  re- 
stricted to  Nature  and  to  Life  as  exhibited  in  the  nervous  systems  of  plants 
and  animals. 

Life  is  Nature's  practical  expression  of  the  law  of  Procreation  by  evolu- 
tion. It  is  exhibited  by  the  generation  of  species  in  plants  and  animals.  It  dif- 
fers from  the  inorganic  combinations  of  elements  by  possessing  physiological 
activity,  hence  all  such  products  are  included  in  organic  chemistry.  Death 
is  the  automatic  return  to  the  inorganic  state.  It  illustrates  the  limitations 
of  Natural  laws,  and  teaches  that  the  so-called  "spirit,"  ''mind,"  "soul,"  evi- 
dently culminate  in  something  analogous  to  the  physically  proved  evolution 
and  that  "purgatories,"  "heavens,"  "hells"  and  "personal  gods"  are  merely 
products  of  imagination. 

The  human  race  has  been  victimized  by  unscrupulous,  self-constituted 
"leaders"  or  "authorities"  ever  since  there  has  been  a  human  race.  Endowed 
by  the  Creative  Power  with  a  mentality  superior-  to  that  of  the  lower 
animals  it  developed  ego.  Ergo,  presto!  it  acquired  a  notion  that  it  is  the 
"image  of  its  creator''  and  to  prove  it  wrote  books  and  advertised  them  as 
the  "word,"  dictated  to  the  conspirators  by  the  creature  of  their  imagination 
and  a  fool  people  believed  the  stuff — because  it  flattered  their  ego.  They 
have  been  believing  it  more  or  less  all  through  the  ages,  because  of  their 
ego.  Even  our  good  friend,  Colonel  Robert  G.  Ingersoll,  fell  for  it  when  he 
said :  "All  I  can  say  about  immortality  is,  I  do  not  know.  There  was  a  time 
when  I  was  not.  Now  I  am  ;  and  it  may  be  that  it  is  no  more  wonderful, 
now  that  I  have  a  start,  that  I  should  live  forever.  We  love,  and  those  we 
love  die  ;  and  we  cling  to  the  wish,  to  the  hope  that  we  may  meet  again.  Love 
was  the  first  to  dream  of  immortality  and  as  long  as  we  love  we  shall  hope." 


120  A  SYSTEM  OF  MATURE  MEDICINE 

Poetry?  Yes,  to  be  sure.  Nothing  more.  I  can  find  no  more  reason  for 
hope  of  a  heaven  than  I  have  found  for  fear  of  a  hell.  They  are  both 
"dreams,"  induced  by  environment,  fear,  credulity  and  indigestion. 

None  of  the  "words"  has  told  anything  about  Life  and  how  to  preserve 
it,  or  how  to  propagate  it.  Their  influence  has  been  altogether  bad.  It  has 
brought  strife,  blood-shed,  misery,  want,  woe,  poverty,  opulence,  religions, 
drugs,  alleged  "laws,"  unions,  sluggers,  murderers,  politicians  and  movie 
actors.  The  people  cater  to  them  all — and  hope.  Far  be  it  from  me  to 
deny  them  the  "blessed  privilege." 

I  have  a  few  remarks  to  make  in  this  chapter  about  Life,  and  the  fol- 
lowing diagram  is  an  outline  of  my  proposition : 


J    Cerebrum \  ,T 

\  Ventricles 

Cerebellum...       .  /  Receiver 

_...,.  \  Distributor 

Cerebro-Spinal 


Cord. 


Ganglia /  Large 

\   Small 

Branches...  .    /  Sensory 

Motor 


Nervous 
System. . . 

,  Systemic /  Organic 

,  General J 

I  Locomotor /  Flexor 

Sympathetic 

f  Chemical..  .   /  Smell 

[   Special Taste 

I  Mechanical /  Vision 

\  Hearing 

The  Nervous  System,  anatomically,  consists  of  the  Brain,  Spinal  Cord, 
Trunk  Lines  and  Branches.  It  ramifies  every  structure  of  the  body  except 
the  hairs,  nails,  parts  of  the  teeth  and  the  cornea-sclerotic  layer  of  the  eyes. 
The  branches  range  in  size  from  the  great  sciatics,  which  are  sometimes 
three-fourths  of  an  inch  broad,  to  so  small  they  cannot  be  traced  with  the 
microscope.  At  points  where  branches  are  given  off  there  are  ganglia 
(knots).  Wherever  many  nerve  branches  meet  they  form  plexuses  (net- 
work). For  convenience  the  trunk  lines  are  divided  into  two  sets:  Cranial, 
twelve  pairs ;  Spinal,  thirty-one  pairs.  The  Cranial  have  names  and  num- 
bers : 

1.  Olfactory:     Origin,  limbic  lobe,  optic  thalamus,  island  of  Reil ;  dis- 
tribution, Schneiderian  membranes  of  nose ;  function,  sense  of  smell. 

2.  Optic:      Origin,   cuneus,    (wedge),   in    each   occipital    lobe;   distribu- 
tion, to  retinae ;  function,  sense  of  vision. 

3.  Motor  Oculi:     Origin,  aqueduct  of  Sylvius;  distribution,  to  all  eye 
muscles  except  the  external  recti    and  superior  oblique ;  function,  motor. 

4.  Trochlear    (pulley)    or   Patheticus:      Origin,   valve   of   Vieussens    in 
roof  of  fourth  ventricle  superficially ;  deep  origin,  floor  of  the  fourth  ventricle; 
distribution,  to  superior  obliques  of  eyes ;  function,  motor. 

5.  Trigeminus   (three  branches)  or  Tri- Facial :     Origin,  floor  of  fourth 


ANATOMY  AND  PHYSIOLOGY  OF  NERVOUS  SYSTEM  121 

ventricle ;  distribution,  skin  and  muscles   of  face,  tongue,  upper  and   lower 
teeth  and  the  eyes,  via  third  nerves;  function,  sensation  and  motion. 

6.  Abducens:     Origin,   fourth  ventricle;  distribution,  external  recti  of 
eyes ;  function,  motor. 

7.  Portio-Dura :   Origin,  fourth  ventricle  ;  distribution,  face,  ears,  palate, 
tongue,  etc. ;  function,  motor. 

8.  Auditory :     Origin,  restiform    (cord-like)   body  of  the   Medulla  Ob- 
longata;  distribution,  internal  ear;  function,  sense  of  hearing. 

9.  Glosso-Pharyngeal :      Origin,    fourth   ventricle;   distribution,   tongue, 
pharynx,  etc. ;  function,  sense  of  taste. 

10.  Pneumogastric  or  Vagus  or  Par  Vagum:    Origin,  fourth  ventricle; 
distribution,  oesophagus,  lungs,  heart,  stomach;  function  sensation  and  mo- 
tion. 

11.  Spinal  Accessory:  Origin,  fourth  ventricle;  distribution,  sterno-clei- 
do-mastoid,  trapezius  muscles,  etc. ;  function,  motor. 

1~>.  Hypo-Glossal  (under  tongue):  Origin,  fourth  ventricle;  distribu- 
tion, hypo-glossus  and  hyoid  muscles;  function,  motor. 

The  Spinal  nerves  are  subdivided  into: 

Cervical    (neck)     8 

Dorsal    (back)    12 

Lumbar  (loins)    5 

Sacral   (sacred)    5 

Coccygeal    (beak)    I 1 

Total    31 

Their  distribution  is  by  way  of  ganglia  and  branches.  The  ganglia  are: 
Superior.  Middle,  and  Inferior  Cervical,  twelve  Thoracic,  five  Lumbar,  five 
Sacral,  on  each  side  of  the  vertebral  column  and  one  Coccygeal,  or  Impar, 
on  the  Coccyx.  These  ganglia  and  their  connections  up  and  down  either  side 
of  the  spine  afford  a  circulation  to  and  from  the  brain  independent  of  the 
cord,  and,  with  the  peripheral  unions  of  a  plexiform  nature  constitute  what 
is  known  as  the  Sympathetic  System. 

The  principal  Spinal  nerves  are  the  Splanchnics,  Superior,  Middle  and 
Inferior,  from  the  middle  and  lower  Thoracic  Ganglia  to  the  abdominal  viscera 
(organs)  ;  the  Obturators,  from  Lumbar  Region  to  hip  joints ;  the  "Sciatics, 
from  Sacral  Region  to  legs ;  the  Anterior  Crural,  from  Lumbar  Region  to 
thighs ;  the  Dorsal,  to  muscles  and  skin  of  trunk ;  the  Pudics  from  sacrum 
to  the  sex  organs  and  anus. 

Physiologically  the  nervous  system  consists  of  the  distribution  of  elec- 
trical force,  acquired  from  Chemical  Reactions  on  food  and  from  the  Me- 
chanical Friction  of  the  body  particularly  the  muscular  division.  The  energy 
generated  is  first  sent  to  the  Cerebellum  and  from  there  it  is  dispatched  to 
all  parts.  The  current  toward  the  brain  is  called  afferent;  that  from  the 
brain  is  efferent. 

The  structure  of  the  anatomical  system  is  white  and  gray  matter;  the 
first  fibrous,  the  second  cellular. 

The  Physiological  Nervous  System  is  the  electrical  current  operating 
the  functions  of  Sensation  and  Motion.  It  is  derived  from  the  body  and  food 


122  A  SYSTEM  OF  MATURE  MEDICINE 

elements,  of  which  there  are  fourteen,  representing  eight  chemical  groups: 

1.  Nitrogen  and  Phosphorus. 

2.  Oxygen  and  Sulphur. 

3.  Hydrogen. 

4.  Iron. 

5.  Chlorine  and  Fluorine. 

6.  Potassium  and  Sodium. 

7.  Calcium  and  Magnesium. 

8.  Carbon  and  Silicon. 

Nitrogen,  Oxygen,  Hydrogen,  Fluorine  represent  Life. 

Phosphorus,    Iron,   Sulphur,    Chlorine         ) 

0    ,.          ,-,  ,  .          ,r  .  represent  sustenance 

Potassium,  Sodium,  Calcium,  Magnesium] 

Carbon  and   Silicon   represent  fat  and  waste. 

The  forms  in  which  these  elements  are  delivered  comprise  mixtures  and 
compounds.  Air  is  a  mixture,  four-fifths  nitrogen  and  one-fifth  oxygen ; 
water  is  a  compound,  eight-ninths  oxygen  and  one-ninth  hydrogen.  Water, 
hydro-chloric  acid,  sodium  chloride  and  a  few  other  combinations  are  simple 
compounds ;  the  rest  are  all  complex  salts,  such  as  nitrates,  sulphates,  phos- 
phates, etc.,  formed  by  the  action  of  active  principles  on  the  metal  bases, 
potassium,  sodium,  calcium,  magnesium  and  iron,  and  on  the  non-metalic 
base,  carbon.  The  latter  being  an  essential  in  a  limited  degree,  after  which 
it  is  a  trouble  maker.  But  this  story  is  too  long  for  this  volume  and  will  be 
reserved  for  Volume  II. 

In  the  earliest  stages  of  the  development  of  the  anatomical  brain  the 
cerebro-spinal  structure  is  called  the  Neural  Tube,  which  gradually  enlarges, 
dividing  into  three  Vesicles,  or  cavities.  Later  these  develop  into  the 
Ventricles  of  the  brain  and  from  the  thickening  of  the  walls  of  the  tube  are 
developed  the  Lobes  of  the  brain  and  the  substance  of  the  Spinal  Cord. 

The  membranes,  or  meninges,  are  the  Dura  Mater  (hard  mother), 
Arachnoid  (spider's  web)  and  Pia  Mater  (tender  mother).  The  first  is  a 
layer  of  protection  to  the  brain  and  cord;  the  last  is  a  convoluted  (rolled) 
layer;  the  Arachnoid  lies  between  the  others,  separated  from  the  inner  one 
by  a  lymph  space ;  it  does  not  dip  down  into  the  fissures  between  the  con- 
volutions of  the  Pia  Mater;  it  does  extend  around  cranial  nerves  until  they 
emerge  from  the  skull. 

The  Dura  Mater  includes :  The  Falx  (sickle)  Cerebri,  an  arched  pro- 
cess, or  partition,  which  dips  down  between  the  two  hemispheres  and  con- 
tains, in  its  upper  and  lower  margins,  the  Superior  and  Inferior  Longitudinal 
Sinuses  (canals),  substitutes  for  veins;  the  Tentorium  Cerebelli,  a  plate 
supporting  the  posterior  lobes  of  the  hemispheres  of  the  Cerebrum,  covering 
the  Cerebellum  and  enclosing  the  Lateral  and  Superior  Petrosal  Sinuses; 
Falx  Cerebelli,  a  partition  between  the  Lateral  Lobes  of  the  Cerebellum 
extending  from  the  Tentorium  to  the  Foramen  Magnum  (opening  for  cord 
to  spine)  ;  Diaphragma  Sellae,  a  horizontal  circular  fold  which  forms  a  roof 
for  the  Sella  Turcica  (Turkish  Saddle)  which  contains  the  Pituitary  (phlegm) 
Body,  in  which  some  profess  to  believe  the  soul  is  housed ;  the  Pacchionian 
Bodies,  near  the  Superior  Longitudinal  Sinus,  the  function  of  which  none 
know. 


ANATOMY  AND  PHYSIOLOGY  OF  NERVOUS  SYSTF.M 


The  Sub-Arachnoidal  Space  contains  Cerebro-Spinal  Fluid  as  do  also 
the  Third  and  Fourth  Ventricles  and  the  Aqueduct  of  Sylvius  which  con- 
nects them. 

The  Pia  Mater  is  highly  vascular  and  nervous,  receiving  blood  from  the 
Internal  Carotid  and  Vertebral  Arteries,  it  distributes  to  the  hemispheres 
through  great  numbers  of  plexuses  by  dipping  down  into  all  the  furrows 
(sulci)  between  the  convolutions  (gyri)  of  the  substance  of  the  hemispheres 
which  consists  of  a  medullary  (marrow)  center  of  white  matter  covered 
by  an  outer  layer  of  gray  matter  known  as  the  cortical  (bark)  stratum. 

The  blood  circulation  is  worth  more  than  a  mere  passing  mention  at 
this  point.  The  Vertebral  arteries  enter  the  skull  through  the  Foramen 
Magnum,  pass  upward  and  forward  in  front  of  the  Medulla  Oblongata  and 
unite  to  form  the  Basilar  artery,  which  has  five  branches  on  each  side : 
The  Transverse,  Internal  Auditory,  Anterior  Inferior  Cerebellar,  Superior 
Cerebellar,  Posterior  Cerebral.  The  Internal  Carotid  arteries  enter  through 
canals  in  the  petrous  portions  of  the  Temporal  bones,  then  branch  into  eight 
on  each  side :  Tympanic,  Arteriae  Receptaculi,  Anterior  Meningeal,  Oph- 
thalmic, Anterior  Cerebral,  MirMle  Cerebral,  Posterior  Communicating  and 
Anterior  Choroid.  The  Circle  of  Willis  is  formed  by  an  anastomosis  (con- 
nection by  special  branches)  of  the  Internal  Carotids  with  the  Basilar;  the 
object  is,  evidently,  to  get  around  the  upper  body  of  the  Sphenoid  bone,  the 
portion  known  as  Sella  Turcica ;  it  is  formed  in  front  by  the  Anterior 
Cerebrals  and  Anterior  Communicating,  on  the  sides  by  the  Posterior  Com- 
municating to  the  Posterior  Cerebrals,  which,  with  the  end  of  the  Basilar, 
form  the  posterior  portion  of  the  Circle  which,  no  doubt  tends  to  equalize 
the  circulation.  The  Middle  Cerebrals  are  the  largest  branches  of  the  In- 
ternal Carotids;  they  pass  obliquely  outward  along  the  Fissures  of  Sylvius 
and  opposite  the  Islands  of  Reil  divide  into  terminal  branches.  The 
Ophthalmic  leave  the  Internal  Carotids  as  they  emerge  from  the  Cavernous 
Sinus  and  enter  the  Orbits  through  the  Optic  Foramen  below  and  outside 
of  the  Optic  Nerve.  The  Anterior  Cerebrals  and  all  other  branches  an- 
astomose freely  and  finally  end  in  Terminal  Arteries,  that  is  those  small 
vessels  which  have  no  further  branches.  The  Posterior  Cerebrals  and  other 
branches  of  the  Basilar  supply  the  Cerebellum  and  posterior  portions  of  the 
Cerebrum.  The  Veins  of  the  brain  do  not  accompany  the  arteries ;  they  are 
without  valves  and  are  called  Sinuses  (canals),  but  need  not  be  confounded 
with  cavities  in  bones,  also  called  sinuses ;  they  are  Superficial  and  Deep, 
of  course.  The  first  named  are  also  called  Cortical  and  the  second  are  known 
as  the  Veins  of  Galen.  The  latter  pass  out  of  the  brain  substance  at  the 
Great  Transverse  Fissure,  about  the  middle  of  the  under  side,  after  receiv- 
ing branches  from  all  directions,  and  empty  into  the  Straight  Sinus,  which, 
with  the  Superior  and  Inferior  Longitudinal,  Lateral,  Occipital,  Superior 
Petrosal,  Circular,  Cavernous  and  Inferior  Petrosal  Sinuses  deliver  venous 
blood  to  the  Internal  Juglar  Vein.  The  Circular  Sinus  is  formed  by  the  two 
Cavernous  Sinuses  on  the  sides  and  the  Anterior  and  Posterior  Inter- 
cavernous  Sinuses  which  connect  them,  in  the  same  region  in  which  the 
Circle  of  Willis  is  located,  and  it  is,  doubtless,  for  the  same  purpose.  The 
External  Carotid  Arteries  and  their  corresponding  Veins  supply  the  neck 


124  A  SYSTEM  OF  MATURE  MEDICINE 

and  face;  they  will  be  treated  in  Volume  II,  which  will,  necessarily  devote 
much  space  to  anatomy  and  physiology  of  the  entire  body. 

The  duality  of  the  brain  is  the  Cerebrum  and  Cerebellum  or  the  In- 
tellectual and  Mechanical.  Its  quadrality  is  completed  when  we  refer  to  the 
Two  Hemispheres  of  the  Cerebrum,  the  Cerebellum  and  Medulla  Oblongata. 

The  duality  of  the  Cerebrum  is  its  Hemispheres,  and  its  quadrality  is 
completed  by  Lobes  and  Ventricles.  Each  hemisphere  is  divided  into  seven 
Lobes;  the  two  hemispheres  form  seven  Ventricles  in  the  space  between 
them.  Really  there  are  only  four  Lobes  on  each  side :  Frontal,  Temporal, 
Parietal,  Occipital;  the  Central  (Island  of  Reil),  under  the  Parietal,  between 
the  Temporal  and  the  median  line,  the  Limbic,  under  the  anterior  beak  of 
the  Corpus  Callosum  (callous  body)  in  the  middle  head,  and  the  Olfactory, 
under  the  Frontal  centrally,  are  merely  processes  of  the  other  eight.  The 
same  truth  applies  to  the  Ventricles:  The  Fourth  is  lowest,  lying  down  be- 
tween the  Cerebrum  and  Cerebellum,  over  the  Medulla  Oblongata;  above  it 
and  slightly  forward  is  the  Third,  connected  with  the  Fourth  by  the  Aque- 
duct of  Sylvius;  a  little  further  upward  and  forward  are  the  Right  and 
Left  Lateral  Ventricles,  connected  with  the  Third  by  a  Y-shaped  opening 
known-  as  the  Foramen  of  Monro;  the  other  Ventricles  are  merely  clefts 
between  the  anterior  portions  of  the  hemispheres.  The  Third  and  Fourth 
Ventricles  and  the  Aqueduct  of  Sylvius  contain  Cerebro-Spinal  Fluid;  the 
others  are  empty,  unless  they  fill  by  a  rising  tide  in  the  lower  Ventricles  dur- 
ing excitement.  I  have  a  theory  that  something  of  this  nature  occurs  and 
that  the  Lateral  Ventricles  are  for  the  purpose  of  maintaining  equilibrium 
of  the  Spinal  Fluids  just  as  the  Circle  of  Willis  and  the  Circular  Sinus  bal- 
ance the  arterial  and  venous  currents.  The  absence  of  such  an  arrangement, 
or  the  deficient  development  thereof  may  account  for  the  exhibits  of  cerebral 
distress  in  some  cases  of  indigestion  or  other  physiological  irritation ;  for 
"strokes"  of  "apoplexy"  and  for  the  paroxysms  of  "epilepsy,"  which  a  Cin- 
cinnati Medical  Trust  doctor  says  is  caused  by  a  bug.  The  contradictory 
evidence  I  have  found  against  my  theory  is  our  successful  treatment  of 
"epilepsy."  Still  we  have  always  cautioned  such  patients  to  be  constantly 
'on  guard  against  over-eating,  indulgence  in  sweets  and  starchy  foods  and 
gave  strict  injunctions  to  avoid  excitement,  such  as  exhibits  in  anger, 
politics,  etc. 

The  Fissures  of  the  Cerebrum  are  for  the  purpose  of  blood  circulation. 
They  are  the  Longitudinal,  separating  the  ? hemispheres,  (the  Corpus  Cal- 
losum forms  the  floor  of  this  fissure  in  the  middle  head)  ;  the  Fissures  of 
Sylvius  on  each  side,  separate  the  Frontal  from  the  Temporal  Lobes  and 
carry  the  Middle  Cerebral  Arteries;  the  Fissures  of  Rolando,  on  the  superior 
surface  of  each  side,  from  the  Longitudinal  Sinus,  about  its  center,  down 
and  forward,  separate  the  Frontal  and  Parietal  Lobes;  the  Parieto-Occipital 
or  Lambdoid  are  short  ones,  on  each  side,  separating  the  Parietal  from  the 
Occipital.  These  four  are  all  of  the  external  ones.  There  are  similar  pro- 
visions on  the  internal  or  under  surface,  the  principal  one  being  the  Trans- 
verse Fissure,  of  a  horse-shoe  shape,  which  transmits  the  Vena  Magna 
Galeni,  or  Veins  of  Galen,  mentioned  in  another  paragraph. 

The  Cerebellum  is  composed  of  white  matter,  centrally,  and  gray  mat- 


ANATOMY  AND  PHYSIOLOGY  OF  NERVOUS  SYSTEM  125 

ter,  externally.  It  is  not  convoluted,  but  is  more  like  a  knotted  cord.  It 
comprises  a  central  division,  the  Vermiform  (worm-like)  process  and  two 
Lateral  Lobes.  It  is  the  storage  battery  of  the  nervous  system.  It  has 
fissures  and  lobes  to  the  number  of  nineteen  and  its  connections  with  the 
Cerebellum  and  Medulla  Oblongata  are  as  complicated  as  the  most  intricate 
electrical  apparatus.  No  one  has  yet  mastered  its  mechanism. 

The  Medulla  Oblongata  or  Spinal  Bulb  is  the  lowest  division  of  the 
Power  House  and  is  the  beginning  of  the  Spinal  Cord. 

The  Pons  (bridge)  Varolii  is  situated  on  top  of  the  Medulla  and  is 
really  a  part  of  it,  being  the  connecting  link  between  the  Cerebrum,  Cerebel- 
lum and  the  Medulla  Oblongata.  It  is  almost  cubic  in  form,  one  and  one- 
half  inches  on  each  side ;  it  lies  between  the  hemispheres  of  the  brain ;  it  is 
full  of  nerve  cells  and  may  be  regarded  as  the  switch-board  of  the  system. 

Ganglia  are  miniature  duplications  of  the  Cerebellum  and  while  an- 
atomically natural  products,  the  same  as  a  knot  in  a  tree  where  branches 
leave  it,  they  have  a  physiological  function  similar  to  the  regulators  of 
electric  curents  at  points  where  they  are  taken  from  main  lines  into  build- 
ings. There  are  a  great  many  of  these  and  sometimes  they  are  formed  in 
plexuses,  the  branches  of  nerves  acting  as  roots  from  which  the  knots  are 
formed.  An  example  of  this  is  found  in  the  Solar  Plexus,  which  is  a  general 
term  covering  the  Phrenic,  Renal,  Gastric,  Splenic,  Hepatic,  Superior  Mesen- 
teric,  Aortic  and  Supra-Renal  Plexuses,  in  which  they  are  many  small 
ganglia  and  two  Semi-Lunar  (half-moon)  ones,  which  are  the  largest  in  the 
body.  This  aggregation  lies  behind  the  pancreas,  in  front  of  the  crura  (legs) 
of  the  diaphragm,  close  to  the  spine  and  aorta,  just  above  the  kidneys.  The 
connections  with  the  spinal  ganglia  are  such  that  in  cases  of  diarrhoea  pres- 
sure put  on  the  spinal  column  in  the  lower  dorsal  region  will  arrest  the 
trouble  by  stopping  the  runaway  current.  The  treatment  must  be  firm  but 
gentle.  There  is  no  need  of  hurting  patients.  For  babies  I  slip  my  hand 
under  the  back  as  they  lie  and  put  on  the  pressure  by  lifting;  for  others  I 
seat  them  in  front  .of  me  and  have  them  lean  back  over  my  knees,  aiding 
by  pulling  upward  and  backward  under  their  arms;  when  it.  begins  to  hurt 
I  relax  a  little,  and,  holding  my  knees  steady,  rock  my  body  back  and  forth, 
sidewise,  carrying  the  patient  with  me.  One  or  two  treatments  is  usually 
sufficient  to  stop  the  worst  case. 

The  so-called  Sympathetic  System  is  simply  the  Physiological  differen- 
tiated from  the  Anatomical  system.  Its  general  function  is  Sensation  and 
Motion,  or  Systemic  and  Locomotor,  the  first  applying  to  the  organic  and 
vasomotor  currents ;  the  second  to  the  muscular  flexion  and  extension  re- 
quired in  our  daily  work.  Its  special  function  is  that  of  feeling,  including 
chemical  senses  of  smell  and  taste  and  the  mechanical  ones,  hearing  and 
seeing. 

There  are  so  many  contributing  causes  of  nervous  derangements  in  con- 
nection with  eye  defects,  which  ought  to  be  looked  after  by  the  Opthal- 
mologist,  that  it  has  been  deemed  advisable  to  present  this  brief  outline  of 
the  nervous  system  in  order  to  encourage  more  thorough  preparation  than 
is  usually  found  to  have  been  accorded  by  those  in  eye  practice. 


126 


A  SYSTEM  OF  MATURE  MEDICINE 


This  plate  shows  the  relation  between  the  two  eyes  and  the  arrangement 
of  the  muscles,  which,  with  the  exception  of  the  inferior  oblique,  arise  from 
the  cartilaginous  substance  in  the  apexes  of  the  orbits. 

1-1 :  External  recti ;  6th  nerves ;  turn  eyes  out. 

4-4 :  Internal  recti ;  3d  nerves ;  turn  eyes  in. 

3-5 :  Superior  obliques ;  4th  nerves ;  prevent  eyes  rolling  on  their  axes, 
outward  at  the  top. 

The  inferior  obliques,  not  shown  in  plate,  arise  from  the  orbital  plates 
of  the  superior  maxillary  bones,  about  opposite  3  ;  they  are  operated  by  the 
3d  nerves  and  are  active  antagonists  of  the  superior  obliques.  See  Chapter 
on  Cyclophoria. 

6  :    Superior  rectus  of  left ;  3d  nerve ;  turns  eyes  up. 

2 :   Inferior  rectus  of  right ;  3d  nerve ;  turns  eye  down. 

7 :  The  optic  or  2d  nerve,  to  the  retina ;  visual  sense. 

8 :  Optic  nerves  commissure  or  switch-yard,  where  the  nerves  divide  and 
cross  over;  the  macula  of  the  right  eye  is  supplied  by  the  left  nerve  and 
that  of  the  left  by  the  right  nerve ;  the  nasal  half  of  the  retina  of  each  eye 
is  supplied  by  the  nerve  from  its  own  side  of  the  head.  It  is  through  this 
nervous  arrangement  that  binocular  vision  is  possible. 

9.    Optic  nerve  sheath  enclosing  optic  nerves  and  retinal  vessels. 

The  levator  palpebrae  superioris  muscles,  not  shown  in  plate,  also  have 
their  origin  in  the  apexes  of  the  orbits. 


CHAPTER  XV. 

Anatomy  and  Physiology  of  the  Eyes  and  Their  Appendages. 

The  orbits  are  the  two  pyramidal  cavities  in  the  skull  which  contain 
and  protect  the  eyes.  The  openings  into  each  are:  The  optic  foramen,  for 
the  optic  nerve  and  opthalmic  artery;  the  sphenoidal  fissure,  a  triangular- 
shaped  opening,  also  known  as  the  foramen  lacerum  anterius,  which  trans- 
mits the  third,  fourth,  sixth  and  branches  of  the  fifth  nerves,  the  orbital 
branch  of  the  middle  meningeal  artery,  a  recurrent  branch  from  the  lachrymal 
artery  to  the  dura  mater,  and  the  ophthalmic  vein;  the  spheno-maxillary 
fissure,  for  the  passage  of  the  orbital  branches  of  the  superior  maxillary 
nerve,  the  ascending  branches  from  the  spheno-palatine  (Meckel's)  ganglion, 
and  infra-orbital  vessels ;  the  infra-orbital  canal  connecting  with  the  face 
through  the  infra-orbital  foramen;  the  canal  for  the  nasal  duct;  the  anterior 
and  posterior  ethmoidal  foramina  for  the  ethmoidal  vessels  and  nasal  nerve; 
numerous  small  foramina  for  the  transmission  of  vessels  and  nerves  to 
nourish  the  bones  forming  the  orbits,  which  are  eleven  in  both  orbits, 
seven  forming  each,  but  three  cranial  bones,  the  frontal,  ethmoid  and 
sphenoid,  form  part  of  each  orbit  while  the  facial  bones,  superior  maxillary, 
malar,  palate  and  nasal,  are  rights  and  lefts.  The  roofs  are  formed  by  the 
orbital  plate  of  the  frontal  and  the  lesser  wings  of  the  sphenoid,  the  latter 
behind.  The  outer  walls  are  formed  by  the  malars  in  front  and  by  the 
greater  wings  of  the  sphenoid  behind.  The  floors  comprise  the  orbital  pro- 
cesses of  the  superior  maxillary  bones,  principally,  with  small  portions  of 
the  malars  in  front  and  of  the  palates  behind.  The  inner  walls  are  formed 
by  the  nasal  processes  of  the  superior  maxillaries,  the  lachrymal,  the  os 
planum  of  the  ethmoid,  and  the  body  of  the  sphenoid.  There  are  depres- 
sions in  the  roofs  for  the  lachrymal  glands,  externally,  and  for  the  carti- 
laginous pulleys  of  the  superior  oblique  muscles,  internally. 

The  apexes  of  the  orbits  are  directed  backward  and  inward,  but  it  does 
not  follow,  as  a  corollary,  that  the  optic  axes  of  the  two  eyes  are  divergent, 
as  has  been  stated  by  garrulous  anatomists  and  reiterated  by  others,  as  we 
have  shown  reasons  why  such  a  condition  would  be  incompatible  with  Na- 
tural laws. 

The  orbital  fascia,  or  connective  tissue,  forms  the  periosteum  of  the 
orbits.  In  some  places  it  is  membranous,  in  others  cartilaginous,  tendinous, 
and  even  muscular ;  it  includes  Tenon's  capsule,  which  surrounds  the  pos- 
terior two  thirds  of  the  globe,  (sometimes  called  Bonnet's),  sheaths  of 
muscles  and  the  muscles,  nerves,  vessels,  areolar  tissue  and  fat  lying  between 
the  eyes  and  their  orbits. 


128  A  SYSTEM  OF  MATURE  MEDICINE 

The  muscles  of  the  globes,  superior,  inferior,  internal  and  external  recti, 
superior  and  inferior  oblique,  and  the  levator  palpebrae  superioris,  originate 
in  the  fascia  in  the  apexes  of  the  orbits,  with  the  single  exception  of  the  in- 
ferior obliques,  which  have  their  origin  in  depressions  of  the  superior  max- 
illary bones  just  in  front  of  the  equator  of  each  eye  and  pass  outward  and 
backward  under  the  eyes,  having  their  insertions  on  the  posterior  external 
sides  of  the  eyes  between  the  inferior  and  the  external  recti. 

The  functions  of  these  muscles  are  respectively:  The  superior  recti,  to 
raise  the  eyes  to  any  desired  plane ;  the  inferior  recti,  to  lower  the  eyes'  to  any 
plane ;  the  interni,  to  converge  the  optical-visual  axes  for  near  work ;  the 
external  recti,  to  restore  parallelism  of  the  axes  after  convergence  and  to 
rotate  the  eyes  outward,  one  at  a  time  in  connection  with  convergence  of  the 
other ;  the  superior  and  inferior  obliques,  to  hold  the  eyes  in  balance  on  their 
axes — not  to  rotate  them  obliquely,  as  is  stated  by  nearly  all  anatomists.  II 
their  story  was  true,  when  the  inferior  oblique  of  the  right  eye  pulled  that  eye 
in  and  down  behind  and  out  and  up  in  front  the  superior  oblique  of  the  other 
eye  would  have  to  push  out  and  down  to  turn  the  front  of  that  eye  up  and  in. 
In  the  chapter  which  treats  of  oblique  astigmatism,  these  oblique  muscles 
play  an  important  part. 

The  nerve  supply  of  the  eye  muscles  all  comes  from  the  third  cranial 
nerves,  except  that  the  fourth  nerves  supply  the  superior  obliques,  the  sixth 
pair  supply  the  external  recti  and  the  ophthalmic  division  of  the  fifth  pair 
reinforce  the  third. 

The  blood  supply  is  from  the  ophthalmic  arteries,  from  the  internal 
carotids,  from  the  common  carotids,  from  the  aorta,  from  the  heart.  It 
returns' through  the  ophthalmic  veins,  to  the  cavernous  sinuses,  to  the 
petrosal  sinuses,  to  the  internal  jugular  vein,  to  the  subclavian  vein,  to  the 
superior  vena  cava,  to  the  heart.  The  orbital  arteries,  from  the  temporal 
arteries,  are  distributed  to  the  upper  orbital  margin.  The  blood  supply  is 
distributed  chiefly  to  the  muscles  and  to  the  second  layer  of  the  globe,  the 
choroid,  which  is  the  medium  of  nourishment  and  nervous  activity  of  the 
optical  apparatus.  The  ophthalmic  arteries  leave  the  internal  carotids  just 
as  those  vessels  emerge  from  the  cavernous  sinuses  and  enter  the  orbits 
through  the  optic  foramina  just  below  and  outside  of  the  optic  nerves;  they 
then  pass  over  to  the  inner  walls  and  divide  into  branches  which  are  nu- 
merous and  may  be  classified  as  the  orbital  and  ocular  groups;  the  former 
comprise  the  lachrymal,  supra-orbital,  anterior  and  posterior  ethmoidal,  in- 
ternal palpebral,  frontal,  nasal,  and  they  supply  the  parts  indicated  by  their 
names ;  the  latter  include  the  long,  short  and  anterior  ciliary,  muscular  and 
arteria  centralis  retinae.  The  last  named  enters  the  globe  with  the  optic 
nerve  through  the  porous  opticus  and  immediately  divides  into  superior 
and  inferior  branches  which  spread  into  nasal  and  temporal  branches  and 
capillaries  which  nourish  the  retina.  The  branches  of  these  arteries  do  not 
anastomose  with  each  other  hence  are  called  "terminal"  arteries.  The 
ophthalmic  veins,  superior  and  inferior,  begin  at  the  inner  angles  of  the 
orbits,  have  the  same  courses,  reversely,  as  the  ophthalmic  arteries,  but  the 
superior  pass  through  the  sphenoidal  fissures  and  empty  into  the  cavernous 
sinuses ;  they  receive  from  the  lachrymal,  anterior  and  posterior  ethmoidal, 


THE  EYES  AND  THEIR  APPENDAGES 


129 


muscular  branches,  and  veins  from  the  eye-lids ;  the  inferior  sometimes  pass 
through  the  spheno-maxillary  fissure  and  empty  into  the  sinus  by  separate 
openings ;  an  unimportant  matter  save  that  it  illustrates  the  inconstancy  of 
some  anatomical  features. 

All  anatomies  contain  such  exaggerated  descriptions  and  illustrations  of 
the  structures  of  the  eye  that  they  are  confusing  to  the  student,  hence  worse 
than  worthless. 


Fig.  97  shows  a  horizontal  section  of  the  eye  enlarged  for  convenience. 
A  is  the  aqueous  humor,  filling  the  space  between  the  cornea  and  lens,  in 
which  the  iris,  10,  floats.  C  is  the  crystalline  humor  which  forms  the  lens, 
contained  between  the  anterior  and  posterior  capsules  2  and  3.  V  is  the 
vitreous  humor  which  fills  the  globe.  1  is  the  cornea;  4  the  retina;  5  the 
pigment  layer;  6  the  choroid ;  7  the  sclerotic;  8  the  optic  disc,  where  enter 
the  retinal  nerves  and  arteries  and  where  the  veins  of  the  retina  find  their 
exit;  9  is  the  canal  of  Schlemm  ;  11  the  canal  of  Petit;  12  the  zonule  of  Zinn ; 
13  the  suspensory  ligaments;  14  the  ciliary  processes;  15  the  circle  of  Zinn, 
around  the  optic  disc  field  where  the  choroidal  vessels  pierce  the  sclerotic ; 
16  the  equator  of  the  globe  in  front  of  which  are  the  chief  attachments  of 
the  rectus  muscles  and  behind  which  are  the  attachments  of  the  obliques. 

The  Sclera  (hard)  or  Sclerotic  Layer,  which  is  the  outer  one  of  the  globe, 
extends  forward  to  the  cornea,  constituting  about  five-sixths  of  the  layer  of 
protection;  it  is  practically  without  nerves  or  vessels,  is  a  dense,  fibrous 


130  A  SYSTEM  OF  MATURE  MEDICINE 

structure,  with  a  lymph  space  between  it  and  the  Capsule  of  Tenon;  it  is 
perfectly  smooth  except  where  the  muscles  have  their  insertion ;  the  recti 
are  attached  about  three-eights  of  an  inch  from  the  sclero-corneal  margin, 
the  obliques  on  the  posterior  temporal  sides.  The  Tunica  Albuginea,  or 
"white  of  the  eye"  covers  the  muscles  anteriorly.  Posteriorly  and  on  the 
inner  half  of  each  globe  the  sclerotic  is  pierced  by  the  optic  nerve  and  its 
accompanying  vessels  at  the  porous  opticus,  or  what  is  seen  with  the 
ophthalmoscope  as  the  optic  disc,  and  in  a  field  around  this,  the  circle  of 
Zinn,  by  the  vessels  to  and  from  the  Choroid.  Anteriorly,  at  the  edge  of  the 
sclera  is  the  Canal  of  Schlemm  which  receives  vessels  from  the  interior  of 
the  eye  and  communicates  with  the  conjunctiva  externally.  Ordinarily  this 
is  invisible,  but  in  severe  internal  congestion  it  sometimes  becomes  injected 
and  appears  as  a  bright  red  ring  around  the  margin  of  the  cornea. 

The  Cornea  (horn)  is  transparent  to  admit  light  to  the  interior  of  the 
globe;  it  is  of  sharper  curvature  than  the  sclera  to  make  up  in  angle  of  inci- 
dence what  the  refracting  media  lack  in  density.  It  comprises  an  anterior 
epithelial  layer,  an  anterior  elastic  layer,  (Bowman's),  the  substantia 
propria  or  cornea  proper,  a  posterior  elastic  layer  and  an  endothelial  layer. 
The  posterior  elastic  layer  is  known  as  the  membrane  of  Descemet  or 
Demours.  The  imagination  of  anatomists  has  been  overworked  to  describe 
the  purpose  of  the  separate  layers  but  it  is  safe  to  pass  it  as  part  of  the  plan 
of  Nature  and  confine  ourselves  to  matters  within  our  comprehension.  The 
cornea  contains  no  nerves  or  blood  vessels  except  such  microscopic  ones  as 
are  necessary  to  its  nourishment.  In  rare  cases  of  long-continued  injection 
of  the  vessels  of  the  orbits,  eyes  and  lids,  corneal  vascularization  develops 
and  almost  always  destroys  vision  permanently.  This  is  one  of  the-  many 
reasons  why  the  public  should  be  taught  to  have  the  eyes  looked  after  by 
competent  practitioners  before  the  evil  days  come. 

The  second  layer  is  one  of  nourishment  and  mechanical  activity.  It  in- 
cludes the  Choroid,  Ciliary  Body  (Processes)  and  Iris.  The  Choroid  is  prac- 
tically all  vessels  and  nerves,  the  veins  being  multitudinous  and  arranged  so 
they  converge  toward  four  or  five  centers  about  the  equator  of  the  globe 
where  they  form  large  trunks,  the  venae. vorticosae,  which  pierce  the  sclera 
and  communicate  with  the  ophthalmic  veins ;  the  arteries  extend  forward 
into  the  Ciliary  Body  accompanying  the  Ciliary  Nerves  and  branches  of  both 
are  sent  to  the  Iris,  particularly  its  margin,  where  they  connect  with  the 
Canal  of  Schlemm,  which  also  connects  with  the  anterior  chamber  through 
the  spaces  of  Fontana.  The  veins  of  the  Ciliary  Body  are  also  numerous  and 
empty  into  the  choroidal  veins  of  which  they  are  a  part.  In  cyclitis,  from 
long  continued  efforts  to  overcome  hypermetropia,  the  injection  of  the  Ciliary 
Body  -becomes  a  hypertrophy  and  if  not  reduced  will  develop  what  is  com- 
monly called  Glaucoma  and  the  eye  will  be  lost.  This  trouble  appears  first 
in  the  fixing  eye,  because,  while  both  are  injected  the  fixing  eye  is  the  first  to 
demand  help;  as  a  result  the  other  eye  is  usually  saved.  The  public  should 
listen  to  reason  instead  of  to  rascals  who,  claiming  to  be  "authorities,"  decry 
the  wearing  of  glasses,  particularly  if  fitted  by  non-medical  practitioners.  It 
is  a  humiliating  fact  that  the  average  oculist  knows  absolutely  nothing  about 
physical  or  physiological  optics,  and  really  believes  that  the  fitting  of  glasses 


THE  EYES  AND  THEIR  APPENDAGES  131 

is  a  minor  matter,  that  sore  eyes  need  medical  treatment,  when  really  properly 
fitted  glasses  and  a  few  days  rest  is  all  that  is  needed  in  nearly  all  cases. 

The  Ciliary  Body  comprises  folds  of  Choroid,  the  suspensory  Ligaments, 
a  cartilaginous  zone  radiating  from  near  the  edge  of  the  crystalline  lens, 
being  separated  from  it  by  the  Canal  of  Petit  and  the  Zonule  of  Zinn,  the  first 
of  which  is  like  a  pneumatic  tire  around  the  edge  of  the  lens  and  the  second 
is  a  network  of  fibres  connecting  the  tire  with  the  suspensory  ligaments ;  the 
office  of  the  first  is  to  pull  against  the  suspensory  ligaments  which  it  cannot 
quite  overcome,  hence,  without  assistance  from  the  sphincter  muscle  and  its 
nerve,  (Muller's  Muscle),  interwoven  circularly  with  the  suspensory  liga- 
ments, which  completes  the  mechanism  of  accommodation,  the  lens  would 
remain  in  a  static  condition.  In  old  age,  when  the  "pneumatic  tire"  loses  its 
elasticity,  the  sphincter  muscle  and  nerve  are  unable  to  do  all  the  work  and 
artificial  assistance  is  required  for  near  work.  This  is  called  Presbyopia,  the 
vision  of  old  age. 

The  Iris  (rainbow)  is  a  muscular  curtain,  formed  of  radiating  and  cir- 
cular fibres,  with  an  adjustable  opening  in  the  center,  the  pupil.  The  circular 
fibres  are  innervated  by  branches  of  the  ciliary  nerves  and  regulate  the 
amount  of  light  admitted  by  contraction  and  relaxation;  the  radiating  fibres, 
being  elastic,  are  the  dilators,  without  innervation.  The  structure  is  invested 
with  a  pigment  layer  varying  in  color  from  black  to  a  pale  green.  The  very 
dark  ones  shut  out  all  light  except  that  which  passes  through  the  pupil;  the 
lighter  ones  admit  some  light  through  the  body  of  the  iris.  In  rare  cases 
there  is  no  pigmentation,  the  iris  hangs  in  the  aqueous  humor  like  a  lace 
curtain  and  the  retina  is  so  overwhelmed  with  light  that  it  actually  dances 
from  the  irritation — this  has  been  called  a  "disease,"  "St.  Vitus'  Dance." 
Such  condition  is  called  Albinism  and  because  of  their  white  hair  and  general 
lack  of  pigment  in  the  skin  such  people  are  called  Albinoes.  The  Iris  is  a 
continuation  of  the  ciliary  body  but  is  connected  with  the  posterior  elastic 
layer  of  the  cornea  by  the  pectinate  ligament.  In  this  ligament  are  the  spaces 
of  Fontana,  mentioned  in  a  preceding  paragraph.  Much  has  been  written 
about  Iritis;  it  is  largely  humbug.  The  Iris  hangs  in  a  chamber  filled  with 
salt  water  and  only  its  edge  could  be  involved  even  in  the  worst  cases  of 
cyclitis.  Operations  are  never  needed  and  could  do  no  possible  good.  See 
chapter  on  "so-called  diseases  of  the  eyes." 

The  Tapetum  Nigrum  or  layer  of  pigment  lines  the  Choroid  and  extends 
forward  through  the  Ciliary  Body  to  the  Iris.  Posteriorily  it  is  a  layer  of 
cells  filled  with  granules,  evidently  for  the  same  purpose  that  the  ground  is 
used  by  electricians — to  take  care  of  surplus  electricity  and  prevent  burning 
out  of  the  delicate  visual  apparatus  of  the  retina.  Some  anatomists  describe 
this  layer  as  part  of  the  Choroid;  others  as  part  of  the  Retina.  It  is  clearly 
neither,  but  is  a  distinctly  separate  layer. 

The  Retina  (net)  is  the  innermost  layer  and  comprises  a  network  of 
nerve  filaments,  arteries,  veins  and  capillaries  beginning-  at  the  edge  of  the 
optic  disk  and  extending  forward  to  the  edge  of  the  Ciliary  Body  about  on 
a  plane  with  the  posterior  surface  of  the  lens.  So  far  as  the  nervous  portion 
is  concerned  it  is  entirely  invisible  with  the  ophthalmoscope,  only  the  vascu- 
lar stratum  being  seen.  Technically,  as  learned  from  microscopic  sections 


132 .  A  SYSTEM  OF  MATURE  MEDICINE 

the  Retina  consists  of  many  layers  of  nervous  structure,  which  are  listed  from 
without  inward  as  follows : 

1.  Layer  of  rods  and  cones,  (Jacob's  Membrane). 

2.  Membrana  limitans  externa. 

3.  Outer  nuclear  layer. 

4.  Outer  molecular  layer,  or  granular  layer. 

5.  Inner  nuclear  layer. 

6.  Inner  molecular  layer. 

7.  Ganglionic  layer. 

8.  Stratum  opticum ;  layers  of  nerve  fibres. 

9.  Membrana  limitans  interna. 

10.     The  fibre  of  Muller  (or  Henle)  connecting  the  above. 

The  Optic  Disc  is  about  one-eighth  of  an  inch  in  diameter  and  is  approx- 
imately its  diameter  from  the  posterior  pole  of  the  eye  on  the  nasal  side. 
The  field  around  this  pole  comprising  a  space  about  twice  as  large  as  the 
Optic  Disc  is  called  the  Macula  Lutea  (spot-yellow).  It  is  the  portion  of 
the  Retina  on  which  images  are  formed  chiefly,  hence  is  most  highly  devel- 
oped. There  is  no  visible  spot,  notwithstanding  the  asseverations  of  Som- 
mering  and  the  reiterations  of  anatomists  who  never  saw  the  inside  of  an  eye. 
The  "fovea  centralis"  is  located  in  the  same  manner  an  engineer  locates 
a  section  line,  not  as  an  alleged  "authority"  locates  a  glass  of  beer. 

The  space  in  front  of  the  lens  and  behind  the  cornea  is  filled  with 
Aqueous  Humor  and  the  Iris  divides  it  into  anterior  and  posterior  chambers. 
This  humor  is  the  only  one  of  the  three  included  in  the  dioptric  system  that 
is  changeable  and  renewable.  It  is  connected  with  the  lymphatic  system  and 
receives  from  it,  discharging  through  the  spaces  of  Fontana  into  the  Canal 
of  Schlemm,  thence  into  the  venous  system.  In  operation  for  cataract  this 
humor  is  all  lost  but  soon  refills  the  space  after  the  cornea  is  replaced. 

The  Crystalline  Humor  which,  with  the  anterior  and  posterior  capsules, 
forms  the  lens,  is  composed  of  many  layers,  beginning  with  a  bi-convex 
nucleus,  like  the  "aplanatic"  lens  described  elsewhere,  and  finishing  with 
anterior  and  posterior  layers  of  negative  meniscus  form,  the  whole  being 
soft  and  adjustable  to  changes  in  the  capsular  surfaces  caused  by  pressure 
of  the  Canal  of  Petit,  or  "pneumatic  tire,"  during  accommodation.  It  was, 
doubtless,  made  thus  striated  for  the  same  purpose  the  "aplanatic"  lens  is 
made,  namely,  to  prevent  chromatic  aberration  ;  hence  "color-blindness"  is 
most  likely  due  to  homogenity  of  construction  of  the  lens  rather  than  to  any 
abnormality  of  the  rods  and  cones  of  the  Retina,  as  proposed  by  other 
writers. 

The  Vitreous  Humor,  which  fills  the  globe,  is  a  semi-fluid  of  vesicular 
structure ;  it  is  evidently  in  constant  motion,  because  in  some  conditions  of 
body  chemistry  there  appear  to  the  victims  "floating  specs"  which  are  opaque 
vesicles,  and  these  opacities  are  dissipated  by  systemic  treatment.  It  is  the 
development  of  this  humor  which  fixes  the  status  of  the  eye  in  many  in- 
stances with  reference  to  Emmetropia,  Hyperopia  and  Myopia;  its  overde- 
velopment occasionally  produces  Malignant  Myopia  and  Posterior  Staphy- 
loma,  a  backward  bulging  of  the  globe  until  the  Chordid  and  Retina  are  torn 


THE  EYES  AND  THEIR  APPENDAGES  133 

from  their  attachments  to  the  Sclera,  destroying  the  Macula  and,  of  course, 
vision. 

The  Hyaloid  Membrane  lines  the  entire  cavity  of  the  globe,  surround- 
ing the  Vitreous  Humor.  In  embryo  it  was  a  canal  leading  to  the 
Crystalline  Lens ;  after  the  lens  was  fully  developed  it  enlarged  with  the 
filling  in  of  Vitreous  and  became  a  membrane ;  it  is  still,  probably,  a  source 
of  nourishment  to  the  Vitreous. 

The  Appendages  of  the  eyes  are  the  Conjunctiva,  Lachrymal  Glands, 
Lachrymal  Sacs,  Nasal  Ducts,  Eyelids  and  Eyebrows  and  the  Muscles 
operating  them. 

The  Conjunctiva  is  the  mucous  membrane  which  lines  the  lids  and 
covers  the  anterior  portion  of  the  eye.  It  is  a  highly  vascular  and  nervous 
structure,  for  protection  against  foreign  bodies,  and,  being  lubricated  by 
the  flow  from  the  Lachrymal  Gland,  the  Lids  work  smoothly  over  it. 

The  Lachrymal  Gland  is  situated  in  a  depression  in  the  upper,  outer 
angle  of  the  roof  of  the  orbit,  receives  its  supplies  from  the  Lymphatic  System 
and  delivers  through  several  small  ducts  piercing  the  Conjunctiva. 

The  Lacus  Lachrymalis  at  the  nasal  end  of  the  opening  between  the 
eyelids,  with  its  puncta  lachrymalia  or  openings  leading  to  the  Lachrymal  Sac 
and  the  Nasal  Duct,  take  care  of  the  flow  of  tears  ordinarily.  When  there  is 
an  overflow  for  any  reason  it  is  no  excuse  for  probing  the  Nasal  Duct. 
Usually  the  cause  is  uncorrected  ametropia,  which  is  easily  and  permanently 
fixed  with  glasses. 

The  Lids  or  Tarsal  Cartilages  (Palpebrae)  for  protection  from  light  and 
other  harmful  influence  and  for  the  distribution  of  the  lachrymal  fluid,  are 
composed  of  skin,  superficial  fascia,  fibres  of  the  Orbicularis  Palpebrarum 
Muscle,  palpebral  and  orbito-tarsal  ligaments ;  the  upper  lid  also  contains  the 
Levator  Palpebra  Superioris  Muscle.  The  lids  are  supplied  liberally  with 
nerves,  blood  vessels  and  lymphatics ;  in  addition  there  are  Sebaceous 
Glands  known  as  Meibomian  Glands,  which  lie  in  grooves  on  the  inner 
surfaces  having  the  appearance  of  bunches  of  small  pressed  grapes ;  their 
ducts  open  on  the  free  margins  of  the  lids  and  their  secretion  is  utilized  to 
moiste'n  the  edges.  What  is  commonly  called  a  Stye  or  Hordeolum  is 
usually  a  Meibomian  Cyst. 

The  Muscles  of  the  Lids  are :  The  Orbicularis  Palpebrarum,  which,,  as  a 
part  of  both  upper  and  lower  lids,  appears  to  be  more  for  elasticity  than  any- 
thing else ;  it  is  supplied  with  energy  via  the  Seventh  Cranial  Nerves.  The 
Tensor  Tarsi,  usually  described  as  a  short  muscle  attached  to  both  lids  at 
the  inner  canthus,  or  angle,  really  composes  the  entire  edge  of  the  lids;  it 
receives  its  nerve  supply  from  the  Third  Cranial  Nerves;  its  office  is  to  hold 
the  edges  of  the  lids  tight  against  the  Cornea  and  by  intermittent  jerks  from 
the  nasal  side,  (winking),  distribute  the  lachrymal  fluid  and  draw  it  toward 
the  Lachrymal  Sac.  The  Levator  Palpebra  Superioris,  is  an  orbital  muscle, 
originating  in  the  apex  of  the  orbit  and  coming  out  over  the  eye  is  inserted 
into  the  upper  lid  as  a  suspensory  antagonist  to  the  Tensor  Tarsi  (Horner's 
Muscle)  ;  it,  too,  is  operated  by  the  Third  Nerves.  The  Corrugator  Super- 
cillii  are  scarcely  eye  muscles ;  they  are  situated  between  the  brows  and 


134>  .     A  SYSTEM  OF  MATURE  MEDICINE 

have  slight  attachment  to  the  inner  upper  corners  of  the  lids;  their  contrac- 
tion corrugates  the  forehead,  hence  their  name;  they  are  supplied  by  the 
Third  Nerves. 

The  student  should  observe  the  muscles  in  the  performance  of  their 
functions,  remembering  that  all  depends  on  their  nerve  supply;  noting  that 
sometimes  two  similar  muscles  work  together,  as  the  internal  recti  in  con- 
vergence, and  sometimes  they  work  singly  as  in  looking  to  the  right  or  left 
one  external  and  one  internal  rectus  work  together.  All  of  the  extra-ocular 
muscles,  the  Recti,  the  Obliques  and  the  Levator  Palpebra  Superioris,  spread 
out  over  large  fields  in  their  insertion. 

A  muscle  is  only  a  medium  through  which  nervous  motor  force  is  utilized. 
The  two  principal  kinds  of  muscular  tissue  found  in  the  body  are  voluntary 
and  involuntary.  The  first  are  known  as  striped  or  striated  and  get  their 
names  from  the  fact  that  they  are  controlled  by  the  will.  The  second  have 
not  the  cross-striped  appearance,  hence  are  known  as  unstriped  or  unstriated. 
They  work  automatically,  chiefly,  hence  are  classed  as  involuntary.  The 
muscles  of  the  heart  differ  in  some  respects  from  both  of  these  groups,  hence 
are  described  as  cardiac  muscle  fibres.  As  this  is  a  very  extensive  subject 
and  as  histological  detail  is  not  essential  in  this  work,  it  will  be  reserved  for 
Volume  II. 


CHAPTER  XVI. 
Physiology  of  the  Eyes  Utilized  to  Measure  Nerve  Supply  and  Demand. 

In  a  bank  the  first  thing  a  clerk  must  learn  is  to  know  what. constitutes 
good  money.  In  all  other  businesses  there  are  equally  sound  standards; 
therefore  it  is  natural  that  the  physician  should  have  them.  In  old  school 
teachings  there  are  standards  of  temperature,  of  heart  beats,  of  respiration ; 
but  they  are  not  utilized  practically  save  to  employ  departures  from  them 
as  means  of  frightening  patients.  To  the  average  physician  if  the  heart 
skips  a  beat  now  and  then  it  is  evidence  of  "mitral  valve  disease."  If  respira- 
tion is  too  rapid  or  too  slow  it  is  a  dreadful  pathological  symptom.  Night 
sweats  mean  "tuberculosis"  to  them ;  and  afternoon  rise  in  temperature  is 
further  "proof."  All  such  stuff  is  humbug,  and,  unfortunately,  pathetically, 
the  doctor  who  believes  it  humbugs  himself.  We  have  proved  this  abun- 
dantly during  the  last  twenty-five  years,  by  correcting  eye  defects  and  other 
causative  factors,  when  all  patients  who  followed  instructions  became  per- 
fectly well.  Another  chapter  will  go  into  this  matter  more  thoroughly. 

We  have  found  in  the  normal  eye  a  guide  to  the  establishment  of  stand- 
ards of  measurement  of  the  nerve  demand  and  supply  under  normal  and 
abnormal  conditions.  To  comprehend  it  we  must  know  the  physiology  of 
the  eyes : 

Nearly  all  people,  including  physicians,  are  under  the  false  impression 
that  good  vision  means  perfect  eyes.  This  is  far  from  the  truth,  because 
careful  statistics  of  10,000  patients  and  3,000  students  has  developed  the  fact 
that  less  than  one  per  cent,  of  all  eyes  are  really  normal ;  ninety  per  cent, 
are  hypermetropic  and  the  balance  myopic  or  blind.  Approximately  seventy- 
five  per  cent,  of  all  hypermetropes  have  normal  vision  and  of  the  remainder 
we  have  been  able  to  give  normal  vision  to  all  but  about  five  per  cent. 

The  normal,  or  emmetropic  eye,  is  physically  perfect  in  its  refracting 
qualities  and  physiologically  perfect  in  its  other  functions,  such  as  retinal 
acuteness,  rotation  of  the  eye-balls,  action  of  the  lids,  lacrymation,  pupillary 
adjustability,  accomodation,  nerve  supply  and  blood  circulation. 

Absolutely  normal  eyes  have  their  optical  axes  exactly  parallel  and  rays 
starting  from  points  on  the  retinae  will  pass  away  from  the  eyes,  after  re- 
fraction, parallel  with  each  axis.  The  visual  axes  are  identical  with  the 
optical  axes.  The  old-school  teachings  are  opposed  to  this,  but  we  shall 
prove  them  wrong  by  their  own  figures  and  by  the  logic  of  the  situation. 

First,  the  alleged   "authorities"  say  that  the  "visual"  axis  of  each  eye 


136  A  SYSTEM  OF  MATURE  MEDICINE 

forms  an  angle  with  the  optic  axis  of  5  degrees.  At  6  meters,  which  is  com- 
monly called  "infinity,"  the  "visual"  axis  would  be  523.5  mm.  from  the  optical 
axis,  because :  The  distance  from  the  posterior  pole  of  the  eye  to  the  optical 
center  is  15.872  mm.,  which,  divided  into  6000,  (the  distance  from  the 
optical  center  to  infinity)  gives  practically  378  to  1  as  the  ratio  of  the 
two  conjugate  focal  distances,  hence  represent  the  relative  sizes  of  object  and 
image  so  located.  The  distance  of  the  "visual"  axis  from  the  optical  axis  at 
infinity,  representing  5  degrees,  is  523.5  mm.,  because  a  circle  with  a  radius 
of  6,000  mm.  has  a  diameter  of  12,000  mm.  and  a  circumference  of  37,699  mm., 
which,  divided  by  360  (degrees)  and  the  quotient  multiplied  by  5,  gives  523.6. 
Regarding  this  as  the  size  of  the  object  we  divide  it  by  378  to  get  the 
distance,  (regarded  as  the  size  of  the  image),  from  the  optical  to  the  "visual" 
axis  at  the  retina.  This  division  gives  1.385  mm. 

As  the  average  pupillary  distance  is  60  mm.  we  take  one-half  of  it,  30 
mm.,  as  the  distance  from  the  optic  axis  of  either  eye  to  the  median  line  of 
the  head ;  deducting  that  amount  from  523.6  leaves  493.6  mm.,  from  the 
.median  line  at  6  meters;  then  adding  1.3865  to  the  distance  from  the  optical 
axis  to  the  median  line,  30,  we  have  31.3865  from  the  visual  axis  to  the  median 
line  at  the  retina  to  compare  with  493.6  at  infinity,  which  is  as  1  is  to  15.72. 
The  distance  from  the  retina  to  the  point  where  the  "visual"  axis  crosses 
the  median  line  represents  one  conjugate  focal  distance  and  the  distance 
from  the  crossing  point  to  infinity  represents  the  other  one.  The  first  men- 
tioned is  to  the  second  as  1  is  to  15.72  ;  and  dividing  the  sum  of  the  distances, 
6015.872,  by  the  sum  of  the  ratios,  16.72,  gives  the  distance  from  the  retina 
to  the  crossing,  point  on  the  median  line,  which  is  a  fraction  less  than  360  mm. 
or  about  344  mm.  from  the  optical  center  of  the  eye,  a  point  approximately 
14  inches  from  the  face.  This  proves  the  "authority"  story  is  false. 

Now,  taking  the  30  mm.  from  the  optic  axis  to  the  median  line  at  infinity 
and  dividing  it  by  378,  the  ratio  between  the  two  conjugate  focal  distances, 
•we  find  the  distance  from  the  "visual"  axis  to  the  optic  axis  at  the  retina 
would  be  .0793,  a  trifle  less  than  8/100  of  a  millimeter.  Inasmuch  as  the 
entire  macular  field  is  highly  sensitized  in  order  to  receive  images  at  all,  this 
would  be  negligible  if  there  really  was  a  "visual"  axis.  But  we  shall  now 
see  that  it  is  not,  because  it  would  not  be  logical  in  view  of  the  relation 
between  accommodation  and  convergence :  Six  meters  is  one-sixth  of  a 
diopter,  and,  for  an  emmetrope  to  fix  on  a  point  at  that  distance,  such  an 
amount  of  accommodation  (adjustment  of  the  crystalline  lens)  must  be  em- 
ployed. As  convergence  is  absolutely  necessary  for  near  points  and  comes 
automatically  with  the  act  of  accommodation  it  would  be  remarkable  indeed 
if  it  delayed  action  while  the  accommodation  worked  one-sixth  of  a  diopter; 
but,  worse  than  that,  if  the  emmetrope  wanted  to  look  at  a  remote  distance 
he  would  have  to  exert  nerve  force  through  the  external  recti  muscles  and 
diverge  the  optical  axes !  Would  any  reader  be  foolish  enough  to  build  such 
an  apparatus  when  he  could  make  it  more  effective  by  making  the  optical 
and  "visual"  axes  on  the  same  lines?  We  do  not  believe  you  would  and  we 
are  sure  Nature  never  did  such  a  thing. 

The  optical  and  visual  axes  of  the  eyes  being  on  the  same  lines  and 
the  eyes  emmetropic,  there  is  no  demand  on  the  nervous  system  when  look- 


MEASURING  NERVE  SUPPLY  AND  DEMAND 


137 


ing  at  a  distance.  To  be  absolutely  exact  there  would  be  1/1584  of  a  diopter 
demand  for  accommodation  in  each  eye  and  half  as  much  for  convergence 
in  each,  when  fixing  on  an  object  a  mile  away;  3/1584  of  a  diopter  in  all; 
but  it  is  not  worth  counting. 

5      5 


V 


To  get  a  good  idea  of  the  mechanism  of  accommodation  let  L.  Fig.  98, 
represent  a  side  view  of  a  bicycle  tire,  c,  held  in  suspension  from  the  outer 
rim,  s  s  s  s  s,  by  the  radiating  lines,  which  being  elastic  but  of  greater  con- 
tractility than  the  bicycle  tire,  keep  it  stretched  to  a  greater  circular  diameter 
than  its  own  elasticity  would  otherwise  permit ;  then  let  the  circular  lines  be 
connected  with  the  radiating  ones  and  let  them  represent  one  continuous 
line,  like  a  watch  spring  and  be  provided  with  an  electric  current  to  wind 
the  spring  so  that  it  will  pull  on  the  radiating  lines  lengthening  them  toward 
L  thus  relaxing  the  tension  on  the  bicycle  tire  and  it  is  plain  that  the  tire 
would  contract  by  its  own  elasticity,  so  that  a  bag  having  spherical  curves 
attached  to  the  tire  at  its  edge  would  change  in  shape  from  L'  to  L2,  shown 
at  left.  Then  let  the  outer  circular  line  represent  the  attachment  of  the 
suspensory  ligaments  at  the  outer  edge  of  the  ciliary  body,  the  radiating 
lines  to  s  s  s  s  s  s  locate  the  position  of  the  suspensory  ligaments,  attached 
to  c,  the  canal  of  Petit,  and  the  circular  lines  indicate  the  arrangement  of  the 
ciliary  sphincter  muscle,  which  upon  contraction,  releases  the  tension  on  the 
bicycle  tire,  c,  and  it  contracts  evenly  from  all  directions,  s  s  s  s  s  s  s,  thus 
changing  the  shape  of  the  crystalline  lens  from  L'  to  L2,  at  the  left,  which  are 
edge  views  of  course,  A  and  A  representing  the  line  of  attachment  corre- 
sponding to  to  s  s  s  s  s  s.s  in  the  drawing  at  the  right.  By  this  ingenious 
arrangement  Nature  relieves  the  nervous  system  of  a  lot  of  strain ;  the  bicycle 
tire  almost  overcomes  the  suspensory  ligaments  and  only  needs  slight  help 
from  the  nerves  operating  the  sphincter  muscle  to  increase  the  lens  power. 
The  proofs  that  this  is  a  correct  explanation  of  the  mechanism  of  accommo- 
dation are :  First,  the  anatomical  arrangement ;  second,  the  fact  that  a  sick 
child  may  lose  the  power  of  accommodation  temporarily  from  loss  of  nerve 
supply,  but  it  is  as  good  as  ever  on  recovery ;  third,  the  decline  in  accommo- 
dative power  with  the  arrival  of  old  age  is  not  due  to  loss  of  nerve  supply 
because  many  old  people  are  stronger  than  they  were  in  youth,  hence  their 
loss  of  accommodation  can  only  be  due  to  loss  of  elasticity  in  the  tissues  of 


138  A  SYSTEM  OF  MATURE  MEDICINE 

the  suspensory  ligaments  and  bicycle  tire,  with  the  result  that  the  resistance 
of  the  suspensories  is  greater  and  the  contractility  of  the  tire  is  less,  and  the 
sphincter  nerves  and  muscles,  never  having  been  required  to  do  all  of  the 
work  refuse  to  do  it  and  artificial  aid  must  be  supplied  by  lenses  for  reading. 

The  normal  -capacity  for  changing  the  power  of  the  crystalline  lens 
ranges  from  16.00  diopters  at  five  years  to  1.00  diopter  at  60  years.  The 
exertion  of  the  full  power  at  any  age  is  exhibited  on  accommodating  to  the 
nearest  point  possible  to  maintain  clear  vision ;  this  is  called  the  near  point, 
or  punctum  proximum.  With  the  nerve  supply  shut  off  the  eye  is  adapted 
to  its  far  point  or  punctum  remotum.  The  distance  between  these  two  points 
is  called  the  range  of  accommodation  and  the  number  of  diopters  power  ex- 
hibited is  the  amplitude  of  accommodation. 

In  establishing  a  standard  of  measurement  of  nerve  supply  and  demand 
I  have  proceeded  as  others  did  in  fixing  standards  in  other  business,  except 
that  I  have  followed  Natural  law  while  they  had  to  work  arbitrarily. 

I  started  with  the  physical  fact  that  a  lens  of  +3.00  power  would  take 
rays  coming  from  a  point  13  inches  away  and  render  them  parallel;  hence, 
an  emmetropic  eye,  receiving  rays  from  such  a  point,  which  is  the  usual 
working  distance,  would  require  a  -(-3.00  lens  to  give  it  the  parallel  rays  for 
which  it  is  adapted,  or  it  would  have  to  change  its  crystalline  lens  approx- 
imately that  amount,  because  that  is  the  only  part  of  the  dioptric  system  of 
the  eye  which  is  adjustable.  Therefore,  when  an  emmetrope  reads  at  any 
distance  we  can  tell  exactly  how  much  work  he  is  doing  with  each  eye  in 
this  respect.  Fixing  on  the  same  object  with  both  eyes  necessitates  con- 
stantly increasing  convergence  as  the  object  is  held  closer.  As  the  distance 
from  the  face  is  measured  in  meter-angles,  one  meter  being  one  meter- 
angle,  half  a  meter  is  two  meter-angles,  one-third  meter  is  three  meter- 
angles,  etc.,  and  as  these  meter-angles  are  compensated  for  in  diopters  we 
have,  respectively  one,  two  and  three  diopters  accommodation  in  each  eye 
for  those  distances.  We  also  have  one,  two  and  three  diopters  of  con- 
vergence, with  this  difference :  the  two  eyes  divide  the  work  each  turning  in 
half  way ;  hence  the  demand  for  convergence  is  only  one-half  as  much  as  for 
accommodation  in  each  eye  for  any  given  distance.  Thus,  for  fixation  at  one 
mile  the  demand  would  be,  for  accommodation  1/1584  of  a  diopter  in  each  eye 
and  1/1584  of  a  diopter  for  convergence  in  the  two  eyes,  the  total  demand 
being  50  per  cent  greater  than  the  demand  for  accommodation.  For  work 
at  the  average  near  point,  one-third  meter,  the  ratio  is  the  same : 

Accommodation  }£"  J'Jjj 
/K..   o.UO 

Automatic  |L    1.50 

Convergence  JR.  1.50 


Total  9.00 

Now,  for  convenience  and  comparative  calculations  a  unit  of  time  is 
necessary  to  measure  the  current,  so  I  chose  1  second  as  the  unit  and  3  hour? 
as  a  day's  work;  therefore 

9x60x60x3  =  97,200 

in  the  three  hours  of  actual  close  work  averaged  daily  by  average  people. 
This    all    comes    from    the    branches   of    the   third    cranial    nerves    operating 


MEASURING  NERVE  SUPPLY  AND  DEMAND  139 

accommodation  and  convergence  only.  There  are  other  branches  of  the  same 
pair  of  nerves  to  the  superior  and  inferior  recti,  the  inferior  oblique,  the 
levator  palpebrae  superioris,  to  the  lachrymal  apparatus,  to  the  Meibomian 
ducts  and  to  the  tensor  tarsi ;  then  there  are  the  fourth  pair  to  the  superior 
obliques,  the  sixth  pair  to  the  external  recti,  the  second  or  optic  nerve  to  the 
retina,  all  of  which  receive  some  nerve  supply  which  we  have  not  been  able 
to  measure  exactly,  but,  compared  with  that  we  have  measured  it  is  so 
slight  that  it  might  be  ignored  entirely.  However,  as  I  need  2800  more  units 
to  make  an  even  100,000  daily  demand  for  the  average  day's  work  for  an 
emmetrope  I  have  credited  that  much  to  those  parts,  and  as  this  addition 
remains  in  all  calculations  it  is  impossible  for  it  to  affect  the  calculation  of 
ratios,  which  is  the  object  of  the  standard. 

The  eyes  receive  their  supply  through  four  and  one-third  pairs  of  nerves, 
the  latter  being  the  ophthalmic  divisions  of  the  fifth,  or.trigeminus,  the  other 
branches  of  which  go  to  the  upper  and  lower  jaws.  The  total  number  of 
pairs  of  nerves  in  the  body  is  43,  of  which  12  pairs  are  cranial  and  31  are 
spinal.  Dividing  these  into  ten  portions  we  have  an  average  of  approx- 
imately four  and  one-third  pairs  to  each  portion.  Allowing  for  each  sub- 
division the  same  amount  of  energy  we  have  figured  for  the  eye  division 
gives  1,000,000  as  representing  100  per  cent,  daily  supply  and  demand  via 
the  nervous  system  in  an  ideally  perfect  person. 

Now,  let  us  take  a  hyperope  of  1.00,  and  consider  all  other  parts  as  nor- 
mal. In  order  to  see  at  an  infinite  distance,  that  is  adapt  his  eyes  to  prac- 
tically parallel  rays,  he  must  accommodate  1.00  in  each  eye;  but,  as  we 
have  seen,  the  provision  for  convergence  with  accommodation  is  automatic, 
hence,  there  is  a  convergent  effort  toward  a  point  one  meter  distant,  which, 
if  permitted  would  cause  diplopia,  or  double  vision,  therefore  the  convergent 
effort  must  be  neutralized  while  accommodation  is  continued  and  the  only 
way  this  can  be  done  is  to  exert  a  negative  pull  by  way  of  the  sixth  nerves  and 
external  recti  to  hold  the  axes  on  the  point  accommodation  has  adapted  the 
dioptric  systems  to.  This  involves  an  extra  demand  on  the  nerve  supply  and 
it  is  an  especially  irritating  one,  because  ordinarily  the  sixth  nerves  are 
only  used  alternately  to  turn  the  eyes  outward  in  looking  to  the  right  or  left. 
The  total  demand  is  expressed  as  follows : 

jL.  1.00 

|   accommodation j 

Third  Nerves 


Accommodation  ^  T> 
Automatic  (L.     .50 


iL- 
JR. 


I  Convergence       (R.     .50 
Sixth  Nerves,  Negative  Pull 

/  £\.,         .OU 


Total  4.00 

As  this  demand  is  to  overcome  an  anatomical  defect  it  is  continued 
during  all  the  hours  one  is  awake,  an  average  of  sixteen  daily.  Multiplying 
4  by  60  by  60  and  16  we  get  230,400  diopters,  units,  or  amperes,  as  you 
please,  as  the  extra  current  demanded  daily  over  the  normal  1,000,000  or 
23.04  per  cent,  for  each  diopter  of  hyperopia,  up  to  the  limit  of  capacity  to 
overcome  such  errors,  which  is  about  5.00  diopters. 


140  A  SYSTEM  OF  MATURE  MEDICINE 

Anyone  can  see  readily  that  such  a  demand  must  have  either  an  enor- 
mous reserve  to  draw  upon  or  work  the  producing  facilities  above  their 
normal  capacity.  Some  have  a  large  reserve  and  continue  a  long  time  with- 
out feeling  serious  effects ;  others  begin  to  feel  it  early  in  life.  The  eyes  are 
the  only  organs  having  facilities  to  conceal  their  anatomical  defects,  hence 
they  have  a  greater  influence  on  the  general  system  than  any  other  part ;  and, 
that  influence  being  exerted  insidiously,  does  lots  of  damage  before  the 
victim  seeks  help ;  then  an  old  school  doctor  "oculist"  is  usually  called  on, 
who,  knowing  no  more  about  eyes  than  his  patients  do,  proceeds  to  treat 
the  effects  instead  of  removing  the  cause,  with  the  natural  result,  failure. 
This,  and  the  fact  that  ninety  per  cent,  of  all  eyes  are  hyperopic,  constitute 
my  reason  for  saying  that  the  primary  cause  of  eighty-five  per  cent,  of  all 
human  ills  is  nerve  strain  through  the  eyes.  The  manner  in  which  these  ills 
develop  is  that  when  the  excess  current  to  the  eyes  is  turned  on  the  entire 
system  is  increased  in  voltage,  with  the  result  that  normal  parts  receive  too 
much  current  and  the  increased  tension  interferes  with  their  work.  It  is 
this  tension  on  the  sphincter  ani  that  causes  so-called  "muscular  imbalance" 
and  much  of  the  .constipation,  indigestion,  piles,  "appendicitis,"  etc. ;  on  the 
sphincter  uteri  it  interferes  with  menstruation,  causing  at  least  great  pain 
at  the  catamenial  period  and  often  stops  the  function  completely,  devel- 
oping complications  from  hysteria  to  "hasty  consumption"  or  neurasthenia. 
It  interferes  with  circulation  by  first  increasing  vascular  tension  and  finally 
the  insufficient  supply  to  the  heart  causes  it  to  exhibit  weakly  even  to  the 
skipping  of  beats.  So-called  "diseases"  of  the  eyes  are  nearly  all  due  to 
uncorrected  errors  of  refraction.  They  exhibit  inflammation,  suppuration, 
granulation  and  ulceration  as  the  four  stages  of  progress  externally;  inter- 
nally, the  most  common  exhibit  is  cyclitis,  or  inflammation  of  the  ciliary  body, 
from  an  injection  of  the  vessels  associated  with  the  extra  supply  of  nerve 
force  in  overcoming  hyperopia;  then  there  are  retinal  exhibits  caused  by 
general  systemic  affections  involving  body  chemistry  and  mechanics.  No 
treatment  for  these  .troubles  is  worth  anything  if  it  is  not  accompanied  by 
correcting  glasses. 

Having  the  nerve  strain  caused  by  1.00  diopter  of  hyperopia  and  having 
learned  how  to  calculate  the  strain  for  any  given  amount  it  is  only  neces- 
sary to  add  that,  as  the  accommodation  is  equally  applied  to  both  eyes,  if 
there  is  a  difference  in  the  amounts  of  error,  we  figure  nerve  strain  as  if 
both  eyes  had  the  same  amount  of  defect  and  we  base  our  calculation  on  the 
fixing  eye.  It  is  discovered  by  having  the  patient  place  his  finger  on  the  tip 
of  his  nose,  then  point  straight  away  at  arm's  length,  both  eyes  open,  until 
he  thinks  he  has  it  directed  at  your  right  eye,  the  left  being  closed.  You 
note  which  of  his  eyes  the  finger  is  in  line  with  as  you  see  it.  In  compound 
cases  the  -(-  sphere  will  always  represent  the  amount  of  error  in  the  most 
hyperopic  meridian,  as  the  prescription  comes  from  the  trial  frame  and  we 
use  that  as  the  final  basis  of  our  calculation.  Thus  a  hyperope,  L.-f-l.oO, 
R.-J-2.00,  R.  the  fixing  eye,  would  be  figured  as  2.00  D.  hyperopia  in  each 
eye;  or  L.+2.00— .50  axis  180,  R.-J-1.50— .75  axis  180,  R.  the  fixing  eye  would 
be  figured  as  if  it  was  a  case  of  simple  hyperopia  of  1.50.  Of  course  in  pre- 
scribing we  would  give  the  full  correction,  with  the  prescription  transposed 


MEASURING  NERVE  SUPPLY  AND  DEMAND  141 

to  L.-J-1.50+.50  axis  90,  R.-f-.T5+.7o  axis  90.  Or,  if  a  patient  is  blind  in 
one  eye  we  figure  his  nerve  strain  the  same  as  if  he  had  two  eyes  alike. 

In  myopia  there  is  no  nerve  strain  through  excess  demand,  unless  there 
is  an  unusual  amount  of  close  work,  when,  by  reason  of  the  very  near  point 
at  which  work  must  be  held  there  may  be  some  excess  demand ;  but  the 
incoordination  between  accommodation  and  convergence  and  the  inability 
to  see  well  at  reasonable  distances  often  causes  mental  worry  which  is  one 
of  the  worst  forms  of  nerve  strain.  A  myope  of  3.00  would  be  able  to  work 
at  one-third  of  a  meter  were  it  not  for  the  necessity  of  convergence,  which 
brings  with  it,  automatical  accommodation,  just  as  accommodation  in  hyper- 
opia  brings  convergence  automatically ;  hence  such  a  case,  converging  to  the 
near  point  would  accommodate  approximately  3.00,  and  this  added  to  his 
myopia  brings  his  far  point,  which  was  originally  at  one-third  meter,  up  to 
one-sixth  meter,  or  about  6f  inches,  requiring  still  more  convergence,  but 
enabling  him  to  see  coordinately  because  the  ratio  of  excess  accommodation 
over  convergence  could  not  be  maintained  above  a  point  farther  away  and 
the  myopia  is  substituted  for  it  so  that  the  points  of  fixation  by  the  dioptric 
systems  and  the  axial  convergence  are  the  same.  Myopes  should  always 
be  slightly  under-corrected  for  distance,  that  is,  do  not  permit  quite  normal 
vision,  because  there  is  great  danger  of  over-correction  which  would  create 
artificial  hyperopia,  a  worse  condition  than  the  real  thing  because  it  puts  a 
sudden  strain  on  a  system  entirely  unprepared  for  it.  For  a  similar  reason 
we  correct  hyperopes  in  full,  that  is,  we  want  to  save  all  of  the  excess 
demand,  and  the  accommodation  resists  so  we  have  to  apparently  overcorrect 
at  first.  In  other  words  our  first  object  in  prescribing  glasses  is  to  relieve 
the  nerve  strain  of  hyperopia;  second,  to  improve  vision,  when  it  is  below 
normal  with  the  naked  eyes.  In  cases  of  myopia  the  object  is  to  improve 
vision  without  causing  any  nerve  strain. 

On  the  pages  following  will  be  given  details  with  reference  to  the  re- 
lations of  nerve  strain  through  the  eyes  as  causative  factors  of  all  sorts  of 
symptoms,  from  ordinary,  dull  headaches  to  periodical  sick-headaches ;  from 
simple  indigestion  to  "chronic  dyspepsia" ;  from  stricture  of  the  esophagus 
to  constipation ;  from  amenorrhoea  to  menorrhagia ;  from  a  rough  skin  to 
psoriasis ;  from  simple  conjunctivitis  to  "trachoma" ;  from  dry,  itchy  eyes  to 
epiphora ;  from  simple  nervous  irritation  to  neurasthenia ;  from  vertigo  to 
epilepsy ;  from  tonic  spasm  to  paralysis ;  from  mental  irritability  to  melan- 
cholia. 

The  table  of  accommodation,  to  be  found  in  the  chapter  describing  the 
Neurometer,  affords  some  interesting  information  with  reference  to  that 
apparatus ;  first,  it  will  be  noted  that  between  the  ages  of  5  and  20  years,  the 
decrease  in  power  is  6  diopters,  or  at  the  rate  of  a  loss  of  one  diopter  every 
2%  years.  From  20  to  30,  there  is  a  loss  of  three  diopters,  or  one  diopter 
every  3%  years.  From  30  to  40  there  is  a  loss  of  2%  diopters,  or  one  diopter 
every  4  years.  From  40  to  50  there  is  a  loss  of  two  diopters,  or  one  diopter 
every  five  years.  From  50  to  60  one  and  one-half  diopters  are  lost,  or  a 
rate  of  one  diopter  every  6%  years.  Thus  the  loss  is  more  rapid  in  youth 
than  in  old  age ;  but  when  we  remember  that  the  near  point  at  the  age  of 
five  years  is  2%  inches,  and  at  twenty  years  is  4  inches,  we  see  that  the  loss 


A  SYSTEM  OF  MATURE  MEDICINE 


of  six  diopters  only  moves  the  near  point  from  the  face  1%  inches,  while 
between  40  and  50,  with  a  loss  of  two  diopters,  the  near  point  recedes  from 
9  to  16  inches ;  and  between  50  and  60,  with  a  loss  of  1%  diopters,  the  near 
point  recedes  from  16  to  40  inches. 

In  order  to  make  all  points  as  clear  as  is  possible  in  a  book,  the  same 
propositions  are  presented  occasionally  in  different  places  in  different  lan- 
guage. It  should  be  understood  by  readers  that  nothing"  can  take  the  place  of 
personal  instruction,  under  conditions  where  the  student  is  at  liberty  to  ask 
questions  freely;  that  while  it  is  our  purpose  to  give  all  the  information  we 
can,  in  the  simplest  language  at  our  command,  there  are  as  many  different 
applications  of  fundamental  principles  as  there  are  patients  in  practice ;  that 
the  amount  of  information  one  gathers  from  a  book  is  governed  largely  by 
the  manner  in  which  it  is  studied ;  that  superficial  reading  is  all  right  for  a 
novel,  but  in  learning  technical  work,  each  department,  even  to  chapters, 
should  be  studied  and  mastered. 

If  the  reader  has  applied  himself  to  Part  I  as  he  should,  he  will  appreciate 
the  coming  chapters  much  better  than  is  possible  without  an  understanding 
of  fundamental  principles.  The  anatomy  and  physiology  of  the  eye  combine 
the  principles  of  mechanics  and  chemistry  to  such  a  degree  that  our  course  in 
Ophthalmology  is  the  foundation  of  our  general  course.  We  have,  almost 
daily,  applications  from  doctors  of  other  schools  of  practice  who  want  to 
take  Neurology  and  skip  Ophthalmology,  because  they  "do  not  care  to  do 
eye  practice."  We  refuse  all  such  propositions,  because  they  could  not  learn 
the  other  work  without  having  Ophthalmology  first.  For  the  same  reasons 
the  student  of  Ophthalmology  must  learn  Physical  Optics  first. 


CHAPTER  XVII. 
. 

Errors  of  Refraction  in  the  Dioptric  System — How  They  Are  Compensated 
for  by  Accommodation  and  with  Lenses. 

Until  very  recently  it  was  not  uncommon  to  hear  the  expression 
"merely  fitting  glasses,"  by  oculists  and  physicians  in  referring  to  the  work 
of  opticians.  In  one  sense  they  were  right ;  the  average  oculist  and  optician 
merely  fits  glasses ;  he  assumes  that  any  glass  he  puts  on,  through  which  the 
patient  sees  as  well  as  without,  is  a  fit.  In  another  sense  they  were  entirely 
wrong;  for  there  is  no  major  surgical  operation  requiring  as  much  genuine 
skill  as  the  correct  fitting  of  a  pair  of  glasses.  It  is  not  a  job  to  be  done  in 
a  few  minutes,  except  in  a.  very  few  cases.  It  cannot  be  done  under  an 
anaesthetic,  nor  even  under  the  influence  of  a  cycloplegic.  There  are  oculists 
and  opticians  or  "optometrists"  as  they  call  themselves,  who  pretend  to  do 
this  work  with  a  mirror  (retinascope  or  skiascope).  These  fellows  differ 
vitally  in  their  opinions :  The  oculist,  who  is  a  licensed  physician,  usually 
without  any  special  knowledge  of  optics  or  ophthalmology,  says  the  mirror 
method  works  only  when  the  patient  is  under  the  effects  of  atropine ;  this 
is  because  he  is  permitted  "legally"  to  use  the  drug,  while  the  optician  is 
not.  The  "optometrist"  says  he  can  do  it  without  the  drug.  He  has  "static" 
and  "dynamic"  skiametry,  and  one  "optometry"  school  advertises  that  it 
teaches  how  to  add  for  reading  with  the  mirror.  1  doubt  very  much  if  any 
of  them  .ever  fitted  a  pair  of  glasses  correctly.  I  have  proved  by  many  tests, 
with  and  without  atropine,  that  the  use  of  the  drug  is  a  mistake.  I  have 
found  that  those  who  employ  it  do  not  know  how  to  tell  when  a  patient  is 
completely  under  its  influence ;  they  know  little  mechanical  ophthalmology 
and  they  rely  on  what  their  preceptors  have  told  them.  Often,  after  the 
pupils  dilated  and  accommodation  appeared  weak,  I  have  found  by  physio- 
logical tests  that  it  was  easily  excited,  hence  would  deceive  any  but  one 
who  knew  how  to  make  the  tests ;  it  is  therefore  unreliable.  As  to  the  claims 
of  those  who  do  objective  testing,  it  makes  them  ridiculous,  because  it  does 
not  even  work  subjectively,  where  we  have  auxiliary  means  of  holding  the 
nervous  system  in  check,  and  working  with  the  mirror  is  always  an  irritation. 
The  method  of  procedure  I  propose  to  describe  does  not  require  or  permit 
the  use  of  drugs ;  indeed  we  could  not  complete  our  work  under  such  con- 
ditions, nor  secure  any  proofs  that  our  procedure  is  effective.  The  oculist 
assumes  that  because  he  does  the  work  it  must  be  correct,  because  he  is 
following  "authorities" ;  the  optician  imitates  the  oculist  as  far  as  he  can. 


144  A  SYSTEM  OF  MATURE  MEDICINE 

We  have  methods  of  proving  every  step  in  our  work,  whether  it  be  physical, 
physiological,  temperamental  or  therapeutic.  The  others  do  not  believe  such 
things  possible,  and  refuse  to  investigate. 

To  do  a  thorough  job  of  fitting  glasses,  the  operator  must  know :  First, 
the  physical  laws  governing  the  matter;  second,  he  must  be  well  trained  in 
physiology  and  the  mechanism  of  the  accommodation  and  convergence 
apparatus;  he  must  know  anatomy,  symptomatology,  dynamic  and  static 
tests  and  what  they  mean  under  all  sorts  of  general  conditions ;  he  must  have 
anticipated  many  situations  and  have  decided  what  he  would  do  if  he  ever 
met  them.  To  illustrate :  About  fifteen  years  ago  an  elderly  man  came 
to  my  office  and  asked  me  what  I  could  do  for  a  peculiar  condition  he  ex- 
hibited, namely,  he  had  lost  not  only  his  power  of  accommodation  for  near 
points  but  his  ability  to  converge  the  axes  of  his  eyes  for  near  points  was 
gone,  so  that  even  with  added  power  of  lenses  for  near  work  he  could  not 
do  it  for  more  than  a  minute,  when  he  saw  double.  I  told  him  I  could  fix  it 
in  a  minute.  He  doubted,  of  course,  because  he  had  just  come  from  the 
then  "greatest"  oculist  in  Chicago,  and  he  asked  how  many  cases  like  his  T 
had  handled.  I  replied:  "I  never  saw  one  before."  He  was  evidently  dis- 
appointed and  wanted  to  know  how  I  knew  I  could  fix  it.  I  told  him  I  knew 
the  law,  because  I  had  anticipated  such  a  case  and  had  it  all  figured  out. 
Then  I  proceeded  to  place  a  five-degree  prism,  base  in,  before  each  eye,  in 
combination  with  his  glasses  for  near  .work.  The  job  was  done.  He  sat  in 
the  office  for  two  hours,  reading  the  morning  paper  with  comfort  for  the 
first  time  in  months.  I  took  the  scales  off  his  distance  lenses  and  gave  him 
a  prescription  for  grab  fronts  containing  his  reading  correction  in  combina- 
tion with  the  prisms.  I  informed  him  that  if  his  power  of  convergence 
returned,  which  was  possible,  all  he  would  have  to  do  would  be  to  have  the 
reading  glasses  made  without  the  prisms.  He  lived  several  years  and  never 
had  to  change  them.  I  have  never  seen  another  case  and  scarcely  expect  to. 
It  is  the  only  time  I  ever  prescribed  prisms,  and  it  was  not  done  to  treat  the 
case  other  than  as  giving  an  artificial  leg  to  replace  a  missing  one  would  be 
treatment.  No  other  sort  of  case  will  ever  need  a  prism.  See  chapter  on 
prisms. 

The  true  ophthalmologist  must  take  into  account  many  other  condi- 
tions beside  eye  defects,  because  if  he  does  not,  even  if  he  could  correct  the 
errors,  he  could  not  hope  for  good  results  in  more  than  a  small  per  cent,  of 
his  cases.  We  take  careful  notes  on  the  appearance  and  the  history  of  each 
case;  make  an  ophthalmoscopic  examination  to  find  systemic  conditions; 
employ  tests  of  vision,  accommodation,  with  and  without  glasses,  static  tests, 
and  record  each  item  carefully  to  be  used  in  analyzing  the  case.  All  of  these 
essentials  are  absolutely  unknown  to  the  oculist  and  optician.  They  cer- 
tainly "merely  fit  glasses,"  if  we  stretch  a  point  and  admit  the  "fit,"  which 
is  a  farce.  If  their  methods  constitute  a  system  of  special  practice  our 
Ophthalmology  is  a  system  of  general  practice. 

It  is  very  doubtful  if  one  in  a  hundred  of  them  could  measure  the  test 
letters  they  use  and  assure  themselves  of  the  correctness  of  the  sizes.  Very 
few  of  the  test  charts  are  correct  and  every  practitioner  should  know  how 
to  measure  them.  A  one-minute  angle  is  the  smallest  that  a  normal  eye 


ERRORS  OF  REFRACTION  145 


can  utilize  for  visual  purposes,  as  has  been  proved  by  repeated  tests  by 
skillful  men.  Test  letters  are  made  on  a  five-minute  basis  because  the  hori- 
zontal lines  in  the  letter  E,  for  example,  are  three  in  number  and  the 
spaces  between  them,  two,  being"  of  equal  width,  each  representing  a  one- 
minute  angle,  constitutes  a  standard  of  five  minutes.  To  find  the  size  of 
type  for  any  distance :  Take  the  distance  as  the  radius  of  a  circle ;  multiply 
its  diameter  by  3.1416;  divide  by  360  degrees;  divide  by  60  minutes;  multiply 
by  5  minutes.  Thus,  the  usual  working  distance  is  20  feet,  or  6  meters ;  the 
latter  equals  6,000  millimeters  as  the  radius  of  the  circle ;  doubling  it  gives 
the  diameter,  12,000  millimeters ;  multiplying  this  by  3.1416  gives  the  cir- 
cumference of  the  circle  at  37,699.2  millimeters;  dividing  this  by  360  gives 
the  number  of  millimeters  per  degree,  104.44;  dividing  this  by  60  gives  the 
millimeters  per  minute,  1.74;  multiplying  this  by  5  gives  the  size  of  the  space 
occupied  by  a  correct  test  letter,  8.7  millimeters.  The  reason  I  have  reduced 
the  figures  to  one  minute  is  that  it  enables  me  to  tell  quickly  the  error  in  a 
letter  which  measures  wrongly.  On  many  cards  the  six-meter  letters 
measure  10  millimeters;  and  this,  divided  by  1.74,  gives  an  angle  of  5.7471 
minutes,  or  5'  42".  A  short  way  to  get  the  five-minute  angle,  is  to  divide 
the  circumference  of  the  circle  by  4320 ;  this  is  because  the  five-minute  angle 
is  one-twelfth  of  60,  therefore  multiplying  360  by  12  gives  4320,  the  number 
of  five-minute  angles  in  any  circle. 

In  Chapter  XII  the  proportions  of  the  normal  eye  are  given  and  refer- 
ence is  made  to  defective  ones.  In  the  first  paragraphs  of  this  chapter  the 
"mere"  method  of  fitting  glasses  is  mentioned  unfavorably.  Let  us  now  pro- 
ceed to  examine  the  matter  in  detail : 


In  Fig.  99  we  have  an  emmetropic  eye,  adapted  to  parallel  rays  R  R, 
which  are  focused  on  the  retina  at  the  posterior  pole  of  the  eye,  without  any 
effort  whatever.  Also  the  rays  divergent  from  F  are  focused  at  the  same 
place,  provided  the  mechanism  of  accommodation  changes  the  surfaces  of 
the  lens  to  the  positions  of  the  dotted  lines.  Of  course  no  one  will  under- 
stand that  an  eye  can  adapt  itself  to  two  positions  at  once.  When  it  is  in 
its  static,  or  natural  condition  it  is  adapted  to  the  parallel  rays;  when  its 
dynamics  are  applied  to  the  lens  it  is  increased  in  power  and  is  holding  the 
retina  in  conjugate  focus  with  F.  The  particular  point  to  be  made  is  that 
accommodation  always  makes  the  lens  more  convex  and  withdrawing  the 
nerve  impulse  only  permits  the  surfaces  of  the  lens  to  resume  their  natural 
relation.  There  is  no  capacity  for  making  the  lens  of  less  power  than  it  has 
naturally.  When  an  emmetrope  exhibits  his  maximum  power  of  accommo- 
dation he  fixes  on  his  near  point,  or  "punctum  proximum,"  as  would-be 
impressive  doctors  call  it ;  the  effort  is  called  his  amplitude  of  accommodation 
and  is  expressed  in  diopters ;  the  range  of  accommodation  is  the  distance  be- 
tween this  near  point  and  infinity,  which  is  his  far  point,  or  "punctum  re- 
motum,"  as  the  aforesaid  would-be  calls  it. 


146  A  SYSTEM  OF  MATURE  MEDICINE 


fa.  /Off 

Fig  100  shows  a  hypermetropic  eye ;  without  accommodation  the  principal 
focal  point  is  at  F  behind  the  posterior  pole ;  with  accommodation,  as  shown 
by  the  dotted  lines  at  the  lens  surfaces,  the  focus  is  at  the  posterior  pole. 
This  accommodative  effort  is  necessary  in  order  to  enable  such  an  eye  to  see 
well.  Ninety  per  cent,  of  all  people  are  hypermetropic,  more  or  less.  All 
such  form  the  habit  of  accommodating  and  develop  extra  strong  muscles  and 
nerves  in  that  department.  Of  course  when  the  defect  is  great  the  excess 
demand  on  the  general  nerve  supply  tends  to  weaken  the  whole  system 
rapidly  and  other  functions  become  involved ;  incidentally  the  accommodative 
power  lessens,  and  after  a  time  the  entire  error  cannot  be  overcome,  hence 
vision  is  affected.  When  -\-  lenses  are  accepted  readily,  with  good  vision,  the 
power  of  the  strongest  lens  so  accepted  is  the  measure  of  the  manifest  hyper- 
metropia;  when  stronger  lenses  can  be  forced  on  by  any  process  and  vision 
become  normal  after  wearing  them  for  a  few  weeks,  the  difference  between  the 
stronger  and  weaker  lenses  is  the  measure  of  the  latent  hypermetropia,  or 
that  which  was  concealed  by  the  active  accommodation.  Many  people,  par- 
ticularly those  under  mature  age,  conceal  all  of  their  hypermetropia,  yet  ex- 
hibit general  disturbances  which  tell  the  ophthalmologist  that  the  eye  defect 
exists.  It  is  our  business  to  make  the  total  amount  of  the  error  manifest. 
This  takes  time,  because  of  the  habit  of  constant  accommodation ;  to  make  it 
manifest  with  a  cycloplegic  would  not  be  satisfactory,  because  as  soon  as  the 
effects  of  the  drug  wear  away,  as  they  do  in  a  few  days,  any  glasses  found 
while  the  accommodation  was  paralyzed  would  not  give  vision  and  would 
not  be  worn  by  the  patient.  There  have  been  many  foolish  notions  exploited 
by  writers  on  the  subject.  Some  advocate  for  children  one-fourth  of  the  full 
correction  found  under  atropine ;  for  young  adults,  one-half,  and  for  older 
ones,  three-fourths.  That  sort  of  practice  would  never  accomplish  anything 
for  those  suffering  from  general  physiological  disturbances,  because  of  their 
eye  strain,  for  the  reason  that  the  eye  strain  would  not  be  removed.  All  it 
would  do  would  be  to  make  a  partial  saving  and  give  good  vision.  By  our 
method  of  procedure,  we  get  good  vision  in  a  few  weeks  and  insure  full 
benefit  to  the  general  condition  by  our  auxiliary  methods  of  handling  cases ; 
so  that  our  ophthalmology  is,  really,  a  system  of  general  practice. 


Fig.  101  shows  how  the  hypermetropic  eye  sees  perfectly  with  the  cor- 
recting lens  after  we  have  induced  the  permanent  relaxation  of  the  nerve 
tension  on  the  lens,  so  that  it  remains  in  its  static  condition,  except  when  it  is 
necessary  to  accommodate  for  near  points,  as  in  Fig.  99.  A  fantastic  idea  of 


ERRORS  OF  REFRACTION  147 


oculist  authors  is  that,  if  the  error  is  corrected  in  full  it  will  cause  atrophy 
of  the  accommodation  from  non-use.  Any  novice  ought  to  be  able  to  see  that 
emmetropes  do  not  exhibit  atrophy,  and  .we  have  only  made  the  hyperme- 
trope  an  emmetrope.  As  a  matter  of  fact,  after  a  hypermetrope  has  been 
corrected  at  a  reasonable  age,  he  is  the  last  to  exhibit  the  presbyopic  condi- 
tion incident  to  old  age ;  this  is  because  "his  department  of  accommodation 
was  developed  above  normal  before  we  corrected  the  error,  and  under  nor- 
mal conditions  he  naturally  holds  out  longer  without  assistance  for  reading 
than  any  other  class,  emmetropic  or  myopic.  The  common  name  for  Hyper- 
metropia  is  far-sight,  but  it  is  only  true  in  the  sense  that  his  nervous  system 
is  irritated  until  vision  is  a  little  keener  than  normal. 


Fig.  102  shows  a  myopic  eye,  with  the  parallel  rays,  R.  R.,  focusing  in 
front  of  the  retina  because  of  the  excessive  power  of  the  static  dioptric  system. 
Accommodation  would  only  make  the  focus  shorter  and  the  resulting  circle 
of  diffusion  at  the  retina  larger,  hence  the  only  way  such  an  eye  can  be  ad- 
justed so  the  retina  will  be  in  conjugate  focus  with  the  object  is  to  bring 
the  object  to  F,  when  there  will  be  sufficient  divergence  to  the  approaching 
rays  to  put  the  focus  back  to  the  retina  as  shown.  For  nearer  points  the 
myope  must  accommodate,  of  course.  The  common  name  for  myopia  is 
near-sight.  It  will  be  seen  readily  that  myopia  is  always  manifest;  the 
only  possibility  is  that  one  who  is  doing  much  near  work  might  exhibit  some 
spasm  of  accommodation  and  manifest  more  myopia  than  really  exists.  There 
could  not  be  any  possibility  of  latent  myopia,  as  anyone  with  a  little  optical 
education  can  see  readily.  Yet  there  are  alleged  "teachers"  of  optics  running 
at  large  who  assert  latent  myopia  is  common.  They  also  teach  that  if  a 
myopic  patient  sees  as  well  with  a  —  3.00  as  with  a  --  2.00  the  —  3.00  is 
the  lens  to  prescribe.  Anyone,  even  a  fool,  ought  to  see  that  the  extra  —  1.00 
would  create  an  artificial  hypermetropia  and  cause  trouble  as  sure  as  there 
is  such  a  thing.  Such  "teachers"  are  of  the  class  who  fit  glasses  with  mir- 
rors and  machines.  This  modest  book  is  so  much  Greek  to  them. 


Fig.  103  shows  how  a  —  lens  takes  the  rays  R  R  and  sends  them  to 
the  eye  as  if  they  came  from  F  thus  enabling  the  dioptric  system  to  focus 
them  at  the  retina  so  the  wearer  can  see  at  a  distance.  Great  care  must  be 
taken  to  not  make  the  lens  too  strong  or  it  will  create  artificial  hyperopia 
and  cause  nerve  strain. 

In  the  course  of  our  work  we  classify  our  cases  many  times : 


148 


First,  as  good,  fair,  medium  or  bad,  in  appearance,  with  reference  to 
health,  development,  proportions,  temperament,  disposition,  mental  balance, 
physiognomy,  social  status,  etc.  All  opinions  are  subject  to  alterations  in 
the  final  analysis,  because  we  have  learned  to  not  believe  our  own  eyes, 
ears,  or  other  senses  without  corroborative  evidence.  No  true  ophthal- 
mologist forms  conclusions  upon  which  he  acts  until  analysis  develops  proofs. 

Second,  family  history  and  details  of  each  case  are  necessary  to  establish 
or  refute  what  the  appearance  tells  us.  After  hearing  a  patient's  story  we 
cross-question  to  bring  out  all  of  the  facts.  Sometimes  one  merely  repeats 
what  he  has  evidently  been  told  by  some  doctor  who  failed  on  his  case 
and  even  made  it  worse  for  us  by  leaving  bad  mental  impressions.  It  is 
this  that  taught  us  the  fact  that  the  mentality  is  always  in  as  bad  condition 
as  the  physiology  of  the  body,  if  not  worse.  The  other  fact  that  people 
grow  angry  when  told  that  such  is  the  case  is  what  proves  the  truth  of  the 
first  proposition. 

Third,  the  ophthalmoscopic  examination  tells  us  the  number  and  calibre 
of  the  vessels  in  all  cases,  gives  us  a  general  knowledge  of  the  circulatory 
system  throughout  the  body,  the  quality  and  quantity  of  blood  in  the 
arteries  and  veins,  and  discloses  any  local  features  which  may  chance  to 
exist  to  offer  possible  interference  with  our  work ;  sometimes  telling  of 
congenital  causes  of  conditions  which  may  cost  the  vision  of  the  patient ;  in 
other  cases  we  find  evidence  of  systemic  changes,  which,  if  not  arrested,  will 
cause  serious  complications.  As  a  means  of  measuring  the  errors  of  refrac- 
tion the  ophthalmoscope  is  of  no  use  whatever.  We  may,  incidentally, 
recognize  high  amounts  of  hypermetropia  or  myopia,  but  that  is  all.  There 
are  people  who  pretend  to  fit  eyes  with  the  ophthalmoscope ;  but  they  are 
deliberate  liars;  a  statement  which  I  stand  ready  to  prove. 

Fourth,  by  a  series  of  dynamic  and  static  tests  we  measure  the  nerve 
supply  as  well  as  the  eye  defects  and  the  auxiliary  causes  of  the  ills  ex- 
hibited, and  by  our  final  analysis,  from  the  data  obtained,  we  find  the  High, 
Safety,  Danger  and  Low  lines  of  each  patient ;  and,  if  we  take  the  case,  we 
stipulate  just  what  Nature  demands  the  patient  must  do  to  get  good  re- 
sults, knowing  what  we  must  do  at  every  stage  of  the  proceedurc,  even  to 
what  charges  to  make  for  our  services,  which  fees  are  collected  in  advance 
that  we  may  have  a  guarantee  the  patient  will  do  what  is  required  and  not 
disgrace  our  system  of  practice  by  dishonest  conduct.  We  know  the  laws 
will  work  if  given  fair  opportunities,  and  we  know  sick  people  are  weak  in 
will  power,  hence  are  unreliable. 

After  the  preliminary  examination,  which  includes  an  examination  of  the 
ears,  nose,  mouth,  teeth,  heart,  lungs,  etc.,  we  proceed  with  the  detailed 
eye  examination,  which,  with  us,  is  a  general  test  of  the  nervous  system. 

The  vision  test  means  much  to  one  who  understands  its  classification. 

First,  normal  vision  does  not  mean  normal  eyes,  but  it  tells  us  there 
is  very  little  if  any  astigmatism ;  there  may  be  lots  of  hypermetropia. 

Second,  better  than  normal  vision,  say  20/15,  is  proof  there  is  no  astig- 
matism worth  correcting,  and  that  there  is  at  least  1.00  D.  hyperopia. 

Third,  less  than  normal  vision  simply  indicates  that  fact ;  it  may  be 
hyperopia  without  accommodation  ;  it  may  be  astigmatism  ;  it  may  be  myopia 


ERRORS  OF  REFRACTION  149 


and  may  be  an  affection  of  the  optic  nerve  or  the  media  through  which  light 
passes  to  reach  the  retina. 

Fourth,  the  same  vision  in  the  two  eyes  does  not  prove  they  are  alike 
in  their  refractive  conditions. 

The  dynamic  test  also  has  its  classifications : 

First,  those  under  approximately  20  years  should  show  at  least  12.00  D. 
accommodation  without  glasses,  and  after  correction  of  hyperopia  should 
show  less  than  at  the  first  test;  not  because  they  have  less,  because  we 
know  they  have  the  amount  of  the  correcting  lens  more  than  they  showed  at 
the  first  test,  but  because  of  the  nearness  of  the  near  point  at  the  first  test 
and  the  prismatic  effect  of  the  -f-  lenses  at  the  second  test  they  should  not 
equal  the  first  showing.  If  they  do  equal  or  exceed  it  we  take  it  as  a  symp- 
tom of  weakness  and  act  accordingly  in  prescribing. 

Second,  those  between  approximately  20  and  35  years  should  show  ex- 
actly as  much  increase  at  the  second  test  as  the  correcting  -)-  lens  amounts 
to.  They  should  show  at  the  first  test  not  less  than  the  amount  indicated 
for  that  class  in  the  Neurometer.  (See  chapter  on  the  Neurometer). 

Third,  those  between  35  and  50  years  should  show  considerable  increase 
at  the  second  test,  even  to  three  times  the  amount  of  the  +  sphere  in  the 
correction,  if  it  is  comparatively  weak,  and  twice  as  much  if  it  is  strong. 

Fourth,  those  over  50  are  often  presbyopic  and"  cannot  register  at  the 
first  test ;  but  they  will  usually  register  after  correction.  If  they  do  not 
we  add  for  reading  and  then  make  the  test  getting  the  maximum  power 
indicated  by  the  near  point  from  which  is  to  be  deducted  the  amount  of  the 
lens  added  for  reading,  the  remainder  being  the  dynamic  showing. 

Anyone  who  exhibits  the  symptoms  of  a  person  of  a  younger  class  is 
giving  evidence  of  nervous  irritation ;  and  any  who  exhibits  the  symptoms 
of  an  older  class  than  that  to  which  he  evidently  belongs,  is  certainly  below 
normal  in  nerve  supply. 

The  static  test  also  has  its  classifications : 

First,  with  the  red  glass  on  the  right  eye  and  the  Maddox  double-prism 
on  the  left,  in  such  a  position  that  the  patient  sees  two  lights  in  a  vertical 
position  at  a  distance  of  fifteen  or  twenty  feet,  where  only  one  exists,  we  un- 
cover the  right  eye,  when  three  lights  should  be  seen  in  a  vertical  line,  with 
the  red  one  exactly  midway  between  the  two  white  ones.  If  it  is  seen  there 
it  is  orthophoria,  that  is  the  eyes  are  in  balance.  If  the  red  light  is  not  in 
that  position  it  is  heterophoria,  a  tending  out  of  balance.  This  only  exhibits 
under  the  test,  when  the  eyes  are  practically  thrown  out  of  gear.  This 
test  may  be  made  with  the  Maddox  rod  over  one  eye,  but  it  is  uncertain  be- 
cause if  the  patient  turns  his  head  it  will  deceive  the  operator ;  and,  it  has 
to  be  placed  in  two  different  positions,  vertical  and  horizontal,  to  complete 
the  test. 

Second,  if  the  red  light  is  seen  to  the  left,  the  axes  are  tending  toward 
each  other  because  of  a  nervous  spasm  exhibiting  through  the  third  nerves 
and  the  internal  recti ;  if  it  deviates  up  or  down,  as  well  as  to  the  left,  it 
merely  indicates  that  the  spasm  is  erratic.  As  a  whole  it  means  that  there 
is  a  spasm  of  accommodation,  not  only  in  the  eyes  but  all  over  the  body;  such 
cases  will  have  constipation,  bladder  trouble,  womb  troubles,  and  other 


150  A  SYSTEM  OF  MATURE  MEDICINE 

evidences  of  tonic  spasm.  We  call  this  the  -|-  impulse,  and  if  it  remains 
after  the  refraction  test  we  know  we  have  to  take  time  to  conquer  that 
spasm,  so  we  give  temporary  lenses  and  order  rest,  baths  and  anything  else 
that  will  conduce  to  general  relaxation.  The  lenses  should  blur  vision  con- 
siderably, too.  Say  to  20/80,  and  the  patient  must  not  look  over  or  around 
them.  He  is  temporarily  nearsighted.  He  can  see  well  if  he  gets  near 
enough  the  objects.  They  cannot  possibly  do  harm.  They  sometimes 
frighten  patients  who  do  not  understand  what  is  being  done  and  they  work 
themselves  into  worse  spasms,  which  irritate  and  inflame  the  eyes,  but  a 
repetition  of  instructions  will  suffice  to  get  people  of  intelligence  to  follow 
instructions  and  they  will  always  come  out  all  right. 

Third,  if  the  red  light  appears  to  the  right  it  is  the  —  impulse  and  means 
the  nervous  system  is  weak,  exhibiting  through  the  same  channels  as  before, 
namely,  the  third  nerves  and  the  internal  recti.  If  the  deviation  is  upward 
or  downward  as  well  as  outward  it  simply  means  the  weakness  is  erratic 
and  intermittent.  Temporary  lenses  and  rest  will  do  such  cases  no  harm  and 
results  will  come  quicker  and  better  by  taking  time  to  the  case. 

Fourth,  If  the  red  light  deviates  up  or  down  and  neither  to  the  right  or 
left,  it  indicates  a  doubtful  tendency ;  another  day  it  might  show  to  the 
right  or  left.  We  handle  it  as  if  it  were  a  -(-  impulse,  to  be  on  the  safe  side. 

All  of  these  deviations  are  merely  symptoms  of  the  nervous  status  and 
never  indicate  muscle  weakness  or  strength.  Whoever  says  it  does  would 
better  study  anatomy  and  physiology  and  learn  that  muscles  are  only 
mediums  through  which  nerve  force  is  applied;  that  there  is  no  such  thing 
as  a  weak  or  strong  muscle ;  that  to  treat  such  cases  with  prisms  is  a  crime 
and  to  operate  on  the  muscles  is  a  double  crime. 

Having  finished  these  tests  and  made  notations  for  reference  both  while 
making  the  refraction  test  and  in  completing  the  analysis,  we  proceed  to 
put  on  -f  spherical  lenses,  settling  on  the  strongest  +  sphere  the  patient 
can  see  the  200  type  dimly  with.  This  tells  us  something  important :  A  + 
1.50  will  fog  an  emmetrope  to  20/200,  hence  if  a  hyperope  can  see  that  well 
with  a  +  3.00  he  must  have  at  least  1.50  hyperopia ;  in  other  words,  after 
finding  the  strongest  -f-  sphere  with  which  a  patient  can  read  20/200,  deduct 
1.50  and  you  have  the  minimum  hyperopia.  There  may  be  more,  but  never 
less.  That  bit  of  information  is  worth  the  cost  of  the  book,  no  matter  what 
you  paid  for  it. 

In  reducing  fogging  lenses  it  must  be  done  deliberately  and  with  skill 
or  the  nervous  system  will  be  irritated  and  the  accommodation  will  act  vig- 
orously. Here  is  where  knowing  the  value  of  the  test  card  comes  in.  Re- 
member the  patient  is  not  under  an  anaesthetic  and  when  you  have  found 
that  —  .25  or  —  .50  brings  the  200  line  clear  and  the  next  line  dimly  you 
must  know  the  value  of  the  distance  between  the  first  and  second  line ;  also 
the  value  of  the  differences  between  all  of  the  other  lines ;  then,  following  the 
principle  all  the  way  down  the  card,  you  will  know  at  once  when  the  ac- 
commodation is  beginning  to  act  against  the  unfogging.  If  -  -  .50  brings 
vision  from  200  to  120,  that  is  80  feet,  theoretically,  the  next  distance,  to  line 
80,  is  forty  feet  and  an  additional  -  -  .25  should  bring  that  line  into  view, 
but,  as  we  start  at  200,  there  is  an  element  of  uncertainty  in  the  amount  that 


ERRORS  OF  REFRACTION  151 


brings  the  second  line  clear,  and  we  can  only  be  certain  by  having  the  patient 
read  aloud  and  as  soon  as  a  line  appears  dimly  have  him  try  to  read  it;  if  he 
misses  no  letters  it  is  counted,  and  so  on  down  two  or  three  lines,  when  we 
are  sure  we  have  his  accommodation  in  control  or  have  positive  evidence 
we  have  not.  Then  we  simply  prescribe  temporary  -|-  spheres  and  have 
them  worn  several  days  to  break  down  the  spasm  and  build  up  the  nerve 
supply  by  rest. 

Unfogging  must  be  done  deliberately  and  with  skill.  Sometimes  it  is 
good  policy  to  come  back  with  two  lenses  of  the  same  power,  say  —  75  and 
-  .75,  after  having  tried  weaker  ones  and  shown  the  patient  that  vision  is 
always  better  with  the  second  lens  at  each  trial.  I  have  taken  cases  from 
20/80  to  20/30  with  the  same  lenses,  pretending;  to  change  them  but  coming 
back  with  the  same  ones  several  times.  This  has  to  be  done  diplomatically 
or  it  may  arouse  suspicion  and  antagonism,  unconsciously,  of  course.  Never 
reduce  the  vision  to  a  point  better  than  the  exhibit  with  the  naked  eye  until 
after  you  have  changed  the  fogging  lens  for  one  representing  the  -f-  diff- 
erence between  it  and  the  unfogging  lens  and  have  made  search  for  astigma- 
tism, when,  if  none  is  found,  leave  that  eye  and  take  the  other  through  the 
same  process.  Then  if  vision  is  not  normal  with  the  two  eyes  it  may  be 
necessary  to  reduce  the  spheres.  If  vision  was  normal  at  first  never  reduce 
to 'better  than  20/30  in  the  unfogging;  and  if  it  was  as  bad  as  20/60  do  not 
reduce  below  that  point  until  you  have  eliminated  the  astigmatism.  There 
are  so  many  little  details  about  the  fitting  process  that  it  is  practically  im- 
possible to  give  them  all  except  in  clinical  demonstrations  during  personal 
instruction. 

If  -f-  lenses  will  not  be  accepted  and  we  find  no  evidence  of  nervous 
spasm,  we  use  the  stenopaic  disk,  or  the  slot,  to  find  if  there  is  any  meridian 
at  which  vision  is  better  than  at  others.  If  there  is  one  we  make  a  note  of 
its  acuteness  of  vision,  then  reverse  the  slot,  that  is  put  it  at  right  angles 
with  the  first  position  and  hold  —  spheres  in  front,  increasing  them  if  neces- 
sary until  that  meridian  sees  as  well  as  the  other  did  without  a  lens.  Then 
we  put  on  a  cylinder,  axis  on  the  good  meridian,  removing  the  slot.  If 
vision  is  not  normal  with  it,  —  spheres  may  be  added,  always  using  the 
weakest  possible  to  get  the  desired  improvement  in  vision;  as  a  rule  do  not 
give  myopes  better  than  20/30  vision  unless  they  are  old  people  whose  ac- 
commodation is  not  liable  to  deceive  you. 

If  -f-  spheres  are  accepted  and  the  search, for  astigmatism  is  to  be  made, 
do  it  in  the  manner  prescribed  in  the  preceding  paragraph,  because  your 
patient  is  an  artificial  myope  with  your  -j-  sphere  on. 

Never  permit  a  patient  to  make  comments  during  the  test ;  require  him 
to  read  the  smallest  letters  he  can  at  each  change  of  lenses ;  have  him  read 
aloud,  that  is  not  second-hand  information,  in  legal  parlance.  You  know 
what  you  want.  He  does  not.  Therefore  stick  to  your  plan  of  work  and 
insist  that  patients  do  as  told. 

Use  8-point  Roman  type  in  making  all  dynamic  tests,  because  the  Neuro- 
meter  is  based  on  that.  In  testing  young  people  have  them  hold  the  paper 
as  close  to  the  face  as  possible ;  then  slowly  push,  away  and  begin  reading 
aloud  as  soon  as  they  can  see  clearly,  stopping  at  that  point.  Measure  it 


152 


A  SYSTEM  OF  MATURE  MEDICINE 


in  inches  or  centimeters  and  express  in  diopters.  For  mature  people,  say 
of  30  years  or  over,  have  test  paper  held  at  the  usual  reading  point  and  then 
drawn  to  the  nearest  point  at  which  they  read  aloud  dimly.  Take  measure  as 
before  and  express  in  diopters.  Occasionally  there  is  a  case  of  nervous  ir- 
ritation in  people  over  30  where  it  is  necessary  to  proceed  as  with  the  young- 
er class  in  order  to  secure  a  reasonable  registration. 

Fig.  104  illustrates  an  astigmatic  chart 
in  common  use.  It  is  usually  made  suitable 
to  the  6  meter  distance,  'and  should  conform 
to  the  measure  of  the  lines  on  the  letter 
chart  for  that  distance.  It  is  extremely  un- 
reliable :  One  without  a  particle  of  astig- 
matism  may  see  the  vertical  lines  much  the 
plainest  because  of  the  habit  of  looking  at 
vertical  objects  has  developed  retinal  sen- 
sibility in  that  meridian  over  the  others  ; 
Another  with  considerable  astigmatism  may 
see  no  difference  in  the  appearance  of  the 
lines.  The  test  with  the  slot  and  letters  is  the  best  of  all ;  but  there  are 
people  who  cannot  use  it.  Then  cylinders  must  be  used,  and,  after  it  is 
found  they  will  give  more  visual  improvement  than  spheres,  the  weakest 
one  which  will  give  the  desired  improvement  must  be  used.  My  method  of 
proving  a  cylinder  is  to  first  hold  in  front  of  the  complete  correction  a  + 
.25  cylinder ;  if  it  improves  vision  I  weaken  the  —  cylinder  in  the  correction ; 
(by  the  proceedure  described  as  the  fitting  process  I  always  have — cylinders 
in  the  trial  frame);  if  it  is  worse  I  offer  .25  --  cylinder;  if  that  improves 
vision  I  compare  the  --  cylinder  with  a  --  .25  sphere,  if  the  sphere  is  best 
the  cylinder  is  proved ;  if  not  I  increase  the  cylinder  .25  and  repeat  the  prov- 
ing test.  If  the  final  cylinder  is  as  weak  as  .50,  even  if  I  have  proved  it,  I 
sometimes  remove  it  for  a  minute,  then  compare  it  with  a  -  -  .25  sphere 
and  if  patient  says  the  sphere  is  best  I  steal  the  cylinder  and  befriend  my 
patient. 

Sometimes,  if  vision  is  good  and  the  same  with  each  eye,  I  fog  and 
unfog  both  eyes  at  once,  in  order  to  save  time.  Of  course  when  the  astig- 
matism hunt  is  on  I  have  to  take,  each  eye  separately. 

After  completing  the  refraction  test  and  proving  it  as  far  as  possible 
at  that  stage,  the  dynamic  and  .static  tests  are  repeated  and  the  data  recorded 
for  later  use,  as  described  in  the  chapter  on  the  Neurometer. 

To  put,  the  entire  story,  of  the  procedure  of  fitting  glasses,  so  far  as  the 
refraction  test  goes,  into  the  smallest  space  possible  we  have  the  following: 
Look  for:  First,  -|-  spheres;  the  strongest  the  patient  can  see  almost 
as  well  with  as  without.  Second,  —  cylinders ;  the  weakest  that  will  ac- 
complish the  purpose  of  improving  vision.  Third,  — -spheres;  the  weakest 
that  will  give  the  vision  desired. 

Possible  results :  First,  a  +  sphere  alone,  indicating  simple  hyperopia. 
Second,  a  -f-  sphere  and  a  —  cylinder,  the  first  to  save  nerve  strain  and  the 
second  to  improve  vision ;  indicating  simple  hyperopic  astigmatism,  if  the 
cylinder  is  of  the  same  power  as  the  sphere ;  compound  hyperopic  astig- 


ERRORS  OF  REFRACTION 


matism,  if  the  cylinder  is  of  less  power  than  the  sphere;  mixed  astigmatism, 
if  the  cylinder  is  stronger  than  the  sphere.  Third,  a  --  cylinder  alone,  in- 
dicating simple  myopic  astigmatism.  Fourth,  a  —  cylinder  combined  with  a 
-  sphere,  indicating  compound  myopic  astigmatism.  Fifth,  a  -  -  sphere 
alpne,  indicating  simple  myopia. 

The  second  of  the  possible  results  is  the  only  prescription  that  ever 
needs  transposing  and  never  needs  it  if  the  —  cylinder  is  more  than  twice 
as  strong  as  the  -f-  sphere.  This  is  a  purely  physical  proposition;  as  a 
physiological  one  we  often  do  transpose  them  when  the  cylinder  is"  more 
than  twice  as  strong  as  the  sphere,  but  we  always  have  abundant  reason  for 
such  proceedure. 

Never  use  cylinders  in  temporary  lenses  except  where  there  is  so  much 
astigmatism  that  there  is  amblyopia  and  the  cylinder  is  put  in  to  improve 
that  condition. 

Temporary  lenses  are  employed  to  break  down  spasms,  to  build  up 
weakened  systems  in  connection  with  rest,  sleep,  baths,  wholesome  food, 
etc. 

\Yhen  we  have  completed  one  examination  we  usually  have  sufficient 
data  to  make  an  analysis ;  if  we  have  not  we  order  rest  and  return  for  further 
examination. 


Some  writers,  in  fact  nearly  all  of  them,  have  advised  against  correcting 
anisometropia,  (differences  of  error  in  the  two  eyes),  and  particularly  against 
correcting  it  for  reading,  giving  as  a  reason  that  it  makes  patients  dizzy  and 
uncomfortable  generally.  They  have  also  made  the  same  statement  with 
reference  to  oblique  astigmatism,  saying  "patients  will  not  tolerate  such  cor- 
rections." This  is  all  nonsense.  I  began  killing  their  idols,  25  years  ago, 
and  have  never  had  a  single  failure,  because  I  know  the  reason  for  the 
alleged  intolerance ;  that  it  was  not  like  the  intolerance  of  drugs,  which  are 
poisonous;  that  it  was  merely  a  matter  of  readjustment  of  the  nervous  sys- 
tem, which  might  be  termed  another  form  of  accommodation.  I  have  always 
given  full  corrections,  explained  to  patients  the  various  things  likely  to 
happen,  from  a  trifling  inconvenience  to  pain  in  the  eyes,  dizziness,  and  even 
sea-sickness ;  but  I  always  assured  them  that  if  they  would  persist  in  wear- 
ing their  glasses,  the  effects  would  soon  pass  away,  and  they  would  be 
delighted ;  that  if  they  looked  over  their  glasses,  or  took  them  off,  it  might 
take  months  to  become  adjusted,  while,  by  following  instructions,  they 
would  be  all  right  in  two  or  three  weeks.  Nearly  all  did  as  directed,  and 
the  results  were  as  promised.  Even  those  who  did  not  follow  instructions 
came  around  all  right  eventually. 

Eyes  without  glasses  become  presbyopic  in  the  following  order:  hyper- 
opes  first;  ametropes  next,  and  myopes  last.  This  refers  only  to  the  wearing 
of  -f-  lenses  for  reading;  the  myope  has  less  accommodation  than  the  emme- 
trope  of  the  same  age,  but  his  myopia  does  much  of  the  reading  work  for 
him,  so  that  he  rarely  needs  lenses  at  all,  and  never  unless  his  myopia  is  less 
than  about  two  diopters.  If  the  ametropia  be  corrected  as  early  as  25  or  30 
years  of  age,  the  order  of  presbyopia'  changes.  The  myope  comes  first,  the 


15-i  A  SYSTEM  OF  MATURE  MEDICINE 

emmetrope  second,  and  the  hyperope  last.  The  reason  for  this  is  that  in  over- 
coming his  hyperopia  with  his  accommodation,  the  ciliary  muscle  and  nerve 
supply  becomes  stronger  than  normal,  just  as  any  other  part  becomes 
stronger  from  extraordinary  use,  and  he  retains  this  excess  development 
for  near  work  after  being  relieved  of  the  distance  strain. 

Much  has  been  written  about  spasm  of  accommodation,  the  varieties 
described  being  almost  as  numerous  as  the  writers.  As  a  matter  of  fact, 
there  are  but  two  kinds :  One  is  the  spasm  of  the  vigor  of  youth ;  and  this 
is  present  often  even  in  sickly  children,  so  that  we  would  better  say  the  vigor 
of  the  youthful  eye ;  this  is  always  so  strong  that  unless  the  operator  is 
thoroughly  conversant  with  possible  conditions  and  causes,  that  is,  knows 
thoroughly  the  physics  and  physiology  involved,  he  will  often  fail  to  get 
good  results  in  nervous  disorders,  and  will  assume  that  there  must  be 
obscure  contributing  causes,  when  he  has  not  found  nearly  the  full  amount 
of  hyperopia.  The  other  form  is  the  spasm  produced  in  older  people  by  the 
continued  effort  of  accommodation  in  overcoming  hyperopia  and  doing  a 
lot  of  near  work  in  addition.  This  variety  is  also  found  in  the  very  young  if 
they  have  much  hyperopia,  and  it  is  practically  the  sole  cause  of  strabismus, 
which  is  described  in  another  chapter.  In  either  of  the  varieties  mentioned, 
the  spasm  may  be  clonic  or  tonic.  The  first  may  be  normal,  that  is,  not 
pathological ;  but  this  is  the  case  only  in  young  children.  The  second  is 
always  pathological,  because  it  means  the  nervous  system  is  so  intensely 
irritated  that  it  cramps;  indeed  it  is  often  indicated  by  pain  in  the  eye- 
balls— some  writers  have  denominated  this  "rheumatism  of  the  eyes."  We 
have  referred  to  this  feature  in  the  chapter  on  alleged  "diseases"  of  the  eyes. 
There  is  no  sharp  line  of  demarcation  between  clonic  and  tonic  spasms,  be- 
cause they  are  like  the  colors  of  the  spectrum,  they  blend  together;  some 
clonic  cases  will  develop  a  tonic  condition  while  we  work  on  them,  and  some 
tonic  spasms  will  break  down  to  the  extent  that  they  become  clonic  while 
we  work.  The  use  of  atropine,  or  other  cyclopegic,  is  not  only  of  no  value 
in  our  method  of  practice,  but  they  cause  inconvenience  to  the  patients,  and 
would  actually  interfere  with  our  analysis  of  our  cases. 


CHAPTER  XVIII. 
The  Neurometric  Method  of  Analysis  of  Conditions  Found  by  Examinations. 

The  Neurometer  (nerve  measure)  is  a  product  of  Natural  laws,  sup- 
ported by  years  of  careful  application  of  the  principles,  proved  by  statistics 
from  clinical  records.  It  is  most  useful  in  practice  because  we  are  not  only 
able  to  analyze  each  case  so  that  we  do  not  prescribe  by  diagnosis,  but  we 
find  the  Natural  resources  of  patients,  make  certain  prognoses  and  fix  the 
fee  in  each  instance.  Having  found  positively  what  Nature  can  do  if  given 
the  opportunity  it  is  then  up  to  the  patient  to  follow  instructions  and  we 
collect  our  fees  in  advance  as  a  guaranty  against  disobedience  and  the  in- 
fluences of  "meddlesome  Matties." 

Some  things  can  be  figured  theoretically  and  some  are  found  only 
through  the  developments  in  practice;  hence,  Theory  and  Practice  are  the 
two  legs  we  stand  on  professionally,  and  to  make  them  equally  good  each 
must  support  the  other. 

Theoretically,  youth  is  physiologically  more  elastic  than  age.  Practi- 
cally, persons  under  about  twenty  years,  in  average  good  condition,  show 
less  accommodation  after  correction  of  hyperopia  than  before.  Of  course 
we  know  that  in  making  the  first  registration  of  accommodative  power  the 
effort  includes  overcoming  the  error  if  it  is  hyperopia,  which  does  not  .ex- 
hibit in  the  registration,  and  we  add  that  amount  to  the  first  showing  to  get 
the  total  dynamic  capacity.  There  are  two  reasons  for  the  exhibit  of  this 
class :  First,  the  nerve  supply  is  so  great  that  they  can  accommodate  to  the 
limit  of  capacity  for  convergence  before  correction  ;  second,  in  making  the 
second  test,  with  lenses  on,  there  are  the  effects  of  prisms  bases  out,  so  that 
there  is  more  convergence  and  accommodation  being  done  than  is  indicated 
by  the  distance  the  card  is  held  from  the  face,  because  the  rays  are  broken 
outward  by  the  inner  halves  of  the  -f-  lenses  and  appear  to  come  from  a 
point  much  nearer,  the  distance  being  regulated  to  some  extent  by  the 
dioptric  power  of  the  lenses.  When  we  add  the  amount  of  error  to  the  first 
registration,  we  have  taken  care  of  that  point,  and  only  need  to  remember 
that  this  is  the  standard  status  of  this  class  and  when  anyone  shows  more 
accommodation  after  correction  than  the  first  showing,  plus  the  amount  of 
hyperopia,  the  whole  is  an  indication  of  weakness  and  the  dynamic  symptom 
is  marked  "bad." 

Between  the  ages  of  20  and  35  years  the  average  good  condition  exhibits 
dynamically  by  showing  an  increase  at  the  second  registration  over  the 


156  A  SYSTEM  OF  MATURE  MEDICINE 

first  of  exactly  the  amount  of  the  hyperopia.  If  any  patient  shows  less  in- 
crease than  this  it  is  an  indication  of  nervous  irritation  which  caused  too 
great  a  showing  at  the  first  test ;  and  if  one  shows  greater  increase  than  the 
amount  of  the  hyperopia  it  is  evidence  of  weakness,  too  small  a  showing,  at 
first  test. 

Between  35  and  50  years  is  a  period  of  variations.  During  the  first 
half  of  this  period  the  showing  at  the  second  dynamic  test  will  be  from  two 
to  four  times  the  amount  of  hyperopia  increase  over  the  first  showing;  but 
during  the  last  half  of  the  period  this  will  be  reduced  until,  sometimes,  when 
there  is  a  great  error,  there  will  be  no  registration  at  the  first  test  and  we 
have  to  accept  the  second  test  at  its  face  value ;  or,  if  there  is  a  register  at 
the  first  test  the  increase  will  only  be  equal  to  the  amount  of  hyperopia,  or 
a  little  more,  at  the  second  test. 

After  50  or  thereabouts,  if  there  is  much  hyperopia  the  first  test  will 
give  no  registration  because  the  accommodation  is  so  weakened  that  it  can- 
not register  near  points ;  and,  sometimes,  there  will  be  no  .registration  at 
the  second  test,  proving  great  weakness ;  but  the  weakness  is  not  nervous 
deficiency,  it  is  from  loss  of  elasticity  in  the  suspensory  ligaments  and  bicycle 
tire — the  loss  of  accommodation  incident  to  old  age,  which  is  called  pres- 
byobia'.  In  these  instances  we  add  -(-  3.00  to  the  distance  correction  and  then 
require  the  patient  to  register.  Taking  his  near  point  we  express  it  in 
diopters  and  deduct  the  3.00  we  gave  when  the  remainder  is  the  dynamic 
showing. 

Recapitulating,  we  have  in  the  foregoing  the  standard  in  each  of  the 
four  classes ;  therefore,  when,  by  the  dynamic  test  any  case  registers  in 
a  younger  class  than  is  actually  true  it  is  an  indication  of  an  irritated  nervous 
system ;  and  if  one  registers  in  an  older  class  than  is  really  true,  it  means 
nervous  weakness.  Also,  if  the  effort  of  accommodation  causes  pain  in 
the  eye-balls  it  is  an  indication  of  irritation  and  if  it  causes  nausea  it  is  an 
evidence  of  great  weakness  of  the  nerve  supply. 

As  a  theoretical  standard  of  accommodation  for  normal  eyes,  doing  a  nor- 
mal amount  of  work,  an  average  of  three  hours  daily  at  approximately  13 
inches,  at  different  ages,  Table  1  is  submitted  with  the  explanation  that  the 
age  figures  are  the  bases  made  for  dynamic  tests,  to  which  are  added  certain 
amounts  in  years,  months  and  days,  for  physiological  strain  and  mental 
temperament,  after  which  deductions  are  made  for  symptoms  exhibited  in 
the  several  tests. 

It  is  a  significant  fact  that  in  utilizing  the  Neurometer  practically  we 
have  found  that  we  cannot  add  anything  for  temperament  in  cases  under 
approximately  20  years  of  age.  This  is  not  because  they  lack  intelligence 
or  common  sense ;  it  is  because  they  have  not  yet  arrived  at  the  point  where 
these  factors  are  working  to  any  great  extent,  being  smothered  by  love  of 
frivolities  and  ego — children  always  think  their  elders  arc  old  fogies  who 
cannot  appreciate  modern  conditions,  when,  as  matters  of  fact,  the  older  ones 
have  been  all  around  the  same  old  circle.  The  weakness  of  the  older  ones 
is  they  are  fanatically  intolerant  and  that  only  works  against  their  influence 
with  the  younger  ones.  When  I  get  in  such  condition  I  am  unable  to  show 
the  young  ones  tricks  I'll  hang  my  harp  on  a  weeping  willow  tree  and  hie 


NEUROMETRIC  METHOD  OF  ANALYSIS 


157 


me  to  a  hermitage.  My  influence  with  the  young  is  that  I  encourage  their 
"foolishness"  but  take  the  conceit  out  of  them  by  telling  them  I  have  been 
worse  than  they  are,  and  proving  it.  Then  they  come  to  me  for  pointers 
and  I  utilize  my  opportunities  to  get  them  interested  in  real,  natural,  rational 
things  which  help  them  to  grow,  mentally  and  physically. 

TABLE  1. 


Nea 
Poi] 

2f 

3 

4 

.r 

at. 

in. 
in.   .  .  .  , 

Diopters. 
16.00... 
14.00.  .  . 

Years. 
5  
10  

Age. 
Months.                 Days. 
0  0.. 
0  ()-. 

in  

.......  13.00... 
,.  1200     . 

12  
15  

6. 
0. 

0.. 
0.. 

in  
in    .  .  .  , 

11.00... 
,  10  00.  .  . 

17  
20  

6. 
0. 

0.. 
0.. 

4 

5 

6 
6|- 

in.   .  .  . 

.  .  .,  9.00.  .  . 

23  

4. 

.0.  . 

in.   .  .  . 

8.50.  .  . 

25  ..... 

0. 

0   . 

in. 

8.00.  .  . 

26  

.  .  ..  8. 

0.. 

in. 

7.50... 

28  

4. 

0.. 

in. 
in. 

,  7.00... 
6.75.  .  . 

30  
31  

0. 
0. 

0.. 
0.. 

in.   .  .  .  , 

6.50.  .  . 

32  

0. 

o.  . 

in    .  . 

'  6  25 

...   33  

.  .   0. 

0   . 

in.   ... 
in.   .  .  . 

6.00... 
5.75.  .  . 

34  
35  

...0. 

0. 

0.. 
0.. 

7 

71 

8 
9 
10 

11 
12 
13 
14 
15 
16 

in.   .  .  . 

5.50.  .  . 

36  

0. 

0.. 

in. 
in.   .  .  . 

5.25... 
5.00.  .. 

37  
38  

0. 
0. 

0.. 
0.. 

in 

4.75.  .  . 

39  

.  .  .0. 

0.. 

in 

450.  .. 

40  

0. 

0.. 

in 

.425.. 

41  

.  .  .3. 

0.  . 

in. 
in 

4.00... 
3.75... 
.        .    3  50 

42  
43  
45  .. 

6. 
9. 
0. 

0.. 
0.. 
0.. 

.   3  25 

.     46 

.  .  .3. 

0.. 

in 

...          .    3  00 

47.  . 

6. 

0.. 

2  75 

48 

.  .  .  9  .. 

0.. 

in.    ... 

.  ..,  2.63... 
2  50 

49  

50 

4. 
0. 

15.. 
0.. 

18 
20 
22 
26 
32 
40 

in. 

2.25... 
2  00 

51  
53 

8. 
4. 

0.. 
0.. 

1  75 

0. 

0.. 

1  50 

56 

.  .  .8. 

0.. 

in.   ... 
in. 

1.25.  .. 
,    1.00.. 

:  58  
60  

4. 

0. 

0.. 
0.. 

158  A  SYSTEM  OF  MATURE  MEDICINE 

TABLE  2. 

If  our  patient  is  an  emmetrope  but  works  extra  hours  over  the  average 
three  upon  which  this  table  is  based,  we  would  add  to  his  showing  by  the 
dynamic  test: 

For  6  hours  extra,  10  years,  0  months. 

For  5  hours  extra,     8  years,  4  months. 

For  4  hours  extra,     6  years,  8  months. 

For  3  hours  extra,     5  years,  0  months. 

For  2  hours  extra,     3  years,  4  months. 

For  1  hour     extra,     1  year,     8  months. 

TABLE  3  A. 

All  calculations  where  hyperopic  errors  -of  refraction  exist  must  include 
an  item  from  the  following  table  with  variations,  unless  especially  exempted : 

ADDITIONS  FOR  HYPEROPIA. 


For  1.00  D. 

add 

10  

.  .  .0.  . 

0 

For     .75  or  1.25 

add 

8  

.  .  .9.  . 

0 

For     .50  or  1.50 

add 

i  7.  . 

.  .  .6.  . 

0 

For  1.75 

add 

6  

..  .3.  . 

() 

For  2.00 

add 

5  

.  .  .0.  . 

0 

For  2.25 

add 

4  

.     7. 

0 

For  2.50 

add 

4  

.  .  .2.  . 

0 

For  2.75 

add 

3  

.  .  .  9  .  . 

0 

For  3.00 

add 

3  

..  .4.  . 

0 

For  3.25 

add 

3  

.  .  .0   . 

20 

For  3.50 

add 

2         

.  .  .9 

10 

For  4.00 

add 

2  

.  .  .6.  . 

0 

For  4.50 

add 

2  

.  .  .3.  . 

0 

For  5  00 

add 

2  

.  .  .0.  . 

0 

This  table  is 

subject  to 

alterations  for  conditions 

found 

by  the  examina- 

tions  and  tests  : 

TABLE  3  B. 

If  the  patient  is  a  hyperope  and  is  working  extra  hours,  too,  it  is  evidently 
just  that  much  worse  for  him,  so  we  figure  the  extra  hours  equal  to  more 
error,  thus : 

6  hours  extra  equals  1.00  D.  more  hyperopia. 

5  hours  extra  equals     .75  D.  more  hyperopia. 
.      4  hours  extra  equals     .75  D.  more  hyperopia. 

3  hours  extra  equals     .50  D.  more  hyperopia. 

2  hours  extra  equals     .50  D.  more  hyperopia. 

1  hour     extra  equals     .25  D.  more  hyperopia. 

If  the  hyperopia  has  been  corrected  in  full  for  a  year  or  more  and  the 
error  is  less  than  1.50,  we  add  to  Table  1  exhibit  for  extra  work  only,  as  if  the 
case  was  emmetropic.  See  Table  2.  If  the  error  is  more  than  1.50  add  for 


NEUROMETRIC  METHOD  OF  ANALYSIS  159 

the  hypermetropia,  even  if  it  has  been  corrected  in  full,  then  add  for  the 
extra  work  as  per  Table  2.  If  the  hyperopia  has  been  partly  corrected  add 
for  the  uncorrected  error,  Table  3A,  plus  the  extra  work,  Table  3B.  If 
a  patient  has  been  wearing  —  lenses  when  -f-  were  needed  there  is  an  artificial 
hyperopia  to  be  added  to  the  real,  so  we  add  for  the  sum  per  Table  3A; 
and,  if  there  is  extra  work,  we  include  it  as  per  Table  3B. 

If  the  dynamic  test  in  any  case,  with  the  correcting  glasses  on,  does  not 
show  a  registration  of  at  least  as  much  more  than  at  the  first  test  as  the  -(- 
sphere  represents  we  add  that  much  to  the  first  showing,  because  the  pa- 
tient must  have  that  much  more  to  overcome  the  error  before  beginning  work 
for  a  near  point.  If  the  second  test  shows  more  increase  than  the  correc- 
tion amounts  to  we  accept  it  because  the  patient  must  have  it  or  he  could  not 
show  it,  after  being  made  emmetropic  with  lenses. 

If  the  static  test  shows  a  +  impulse  after  correction  to  normal  vision 
with  the  strongest  -f~  spheres  we  can  force  on,  we  add  to  the  power  of  the 
spheres  regardless  of  the  vision  it  gives,  because  we  know  there  is  a  spasm 
of  the  entire  nervous  system  and  that  it  is  exhibiting  through  the  third 
nerves  to  the  internal  recti  muscles  and  of  course  involves  the  accommoda- 
tion. If  the  +  impulse  is  anywhere  from  1  to  3  degrees  we  add  -f-  .50  to 
the  spheres ;  if  it  is  4  to  6  degrees  we  add  -f-  .75 ;  if  it  is  7  to  10  degrees  we 
add  -f  1.00;  if  from  11  to  14  degrees  we  add  -f  1.50;  if  more  than  14  degrees 
we  add  +2.00. 

The  relation  between  the  dynamic  and  static  tests  is  a  most  valuable 
one,  because  one  is  a  voluntary  exhibit  and  the  other  is  involuntary ;  in  the 
first  we  require  the  patient  to  exert  his  fullest  capacity ;  in  the  second  we  put 
him  in  a  situation  where  spasm  or  weakness  will  exhibit  in  defiance  of  his 
efforts.  This  has  been  called  a  "muscle"  test  and  what  we  call  the  +  im- 
pulse is  what  the  "muscle"  testers  call  exophoria,  meaning  a  tendency  to 
turn  outward  from  weakness  of  the  internal  recti ;  which  is  a  mistake,  for  it  is 
really  a  tendency  inward  from  too  much  inervation  of  the  internal  recti ;  if  we 
were  naming  it  as  they  do  it  would  have  to  be  esophoria.  Our  —  impulse  is  an 
outward  tending  from  weakness  of  the  innervation  to  the  interni  and  we 
would  call  it  exophoria;  the  others  call  it  esophoria,  from  weakness  of  the 
externi.  Then  they  prescribe  prisms  and  even  operate,  invariably  making 
trouble  unless  the  correcting  lenses  do  more  good  than  their  prisms  or  opera- 
tions do  harm.  This  matter  will  be  taken  up  later. 

The  temperamental  influences  on  the  nervous  system  are  remarkable, 
particularly  on  people  of  mature  years.  There  are  four  general  classes  :  Good, 
Fair,  Medium,  Bad,  with  three  subdivisions  of  each,  as  shown  in  Table  4.  It 
is  also  a  notable  fact  that  the  temperamental  condition  is  almost  invariably 
on  an  equality  with  the  physiological  one,  the  exceptions  being  due  largely 
to  dispositions  developed  by  environment. 

The  dynamic  registration  with  correcting  glasses  on  is  the  patient's  Low 
line;  adding  to  this  according  to  the  other  tables  gives  the  High  line;  the 
Safety  and  Danger  lines  are  found  by  making  equal  divisions  of  the  differ- 
ence between  the  High  and  Low  lines.  Then  Class  1  is  above  the  High ; 
Class  2  is  High;  Class  3  is  below  High  but  not  half  way  to  Safety;  Class  4 
is  more  than  half  way  to  Safety;  Class  5  is  at  Safety;  Class  6  below  Safety 


1GO 


A  SYSTEM  OF  MATURE  MEDICINE 


TABLE  4. 


Physiological 
Classification 

Fee 

Disposition 
and 
Temperament 

Class 

Add  to  Age 
for 
Temperament 

Add  to  fee 
for 
Disposition 

1.  High  + 

125% 

Good 

A  -4- 

12.  .  .0.  ..0 

2.  High 

100% 

Amiable 
Thoughtful 

A 

10.  .  .0.  ..0 

25% 

3.  High  — 

150% 

Considerate 

A 

8.  .   9.  .  .0 

4.  Safety  + 

1     175% 

Fair 

B+ 

8.  .  .9.  .  .0 

5.  Safety 

200% 

Honest 
Critical 

B 

8.  .  .1.    15 

50% 

6.  Safety  — 

300% 

Reasonable 

B—     . 

7.  .  .6..  .0 

7.  Danger  + 
8.  Danger 
9.  Danger  — 

450% 
600% 
900% 

Medium 
Careless 
Heedless 
Dishonest 
Silly 

c+ 
c 
c— 

7...6...0 
6.  .10.  .15 
6...3...0 

75% 

in     T  nw    1 

Bad 

T^    1 

6.  .  .3..  .0 

nT.nw 

94003^1 

Stubborn 
Fanatical 

L>+ 

5.  ..7..  15 

100% 

12.  Low- 

500O% 

Deceitful 
Vicious 

D— 

5.  ..0...0 

but  not  half  way  to  Danger ;  Class  7  is  more  than  half  way  to  danger ;  Class 
8  is  Danger;  Class  9  is  below  Danger  but  not  half  way  to  Low;  Class  10  is 
more  than  half  way  to  Low;  Class  11  is  Low;  Class  12  is  below  Low.  When 
a  patient  is  older  than  his  High  line  it  indicates  a  dangerous  spasm  condi- 
tion, and  he  is  really  as  much  below  his  high  line  as  he  appears  to  be  above 
it.  If  one  is  at  Low  — ,  or  Class  12,  and  is  still  able  to  get  around,  there  is 
something  wrong  with  his  registration.  Ophthalmologists  do  not  take  cases 
who  are  physiologically  below  Class  6.  They  are  for  Neurologists. 

To  utilize  these  tables  there  must  be  a  regular  procedure,  indicated  by 
the  following  blank  forms,  which  are  filled  and  the  records  proved  before 
we  can  begin  the  analysis  of  a  case : 


Symptoms. 


Appearance : 

History :   

Ophthalmoscope : 

Vision :   

Dynamics :   

Statics :     

Correction    

Vision :   , 

Dynamics : 

Statics : 

Pupillary  Distance  : , 

Nose  High  : Base  Wide  : Crest : . 

Size  of  Lens  : Between  Lenses  : .  . . . 

Temple  Distance  : Style  of  Guard : . . . 


Discounts  for  Symptoms 
Points  in  Ten: 

Good,  1  to  2. 

Fair,  3  to  4. 

Medium,  5  to  6. 

Bad,  7  to  10. 

,  Symptom  Classification: 
Pts. 

App 

His 

Oph. 

Dyn 

Stat 

Total  Points   

Per  cent,  of  50  . 


NEUROMETRIC  METHOD  OF  ANALYSIS  161 

Finally,  the  case  is  analyzed  by  using  the  next  form,  getting  the  data 
from  the  forms  above.  Discount  temperament  half  as  much  per  cent  as  for 
hyperopia  and  extra  work,  because  the  strain  is  not  so  direct  nor  so  constant. 

Years     Months     Days  Years    Months    Days 

Dynamics  :    D 

Hyperopia :  D less  — % 

Extra  Work :    Hrs less  — %   

Temperament :  less  — %   

High    Line    

Safety  Line   Condition ...... 

Danger  Line ' 

Low  Line   Date  of  Examination  

Remarks  :    Patient  Born  :   

Age :   


If  the  condition,  with  reference  to  the  High,  Safety,  Danger  and  Low 
lines  does  not  put  the  patient  in  the  same  class  the  actual  age  does,  and  within 
a  few  weeks  of  the  same  date,  there  is  something  wrong  with  the  calculation 
or  the  work.  See  Table  4,  physiological  classification.  If  the  patient  is 
actually  younger  than  indicated  by  the  Condition  we  may  have  erred  in 
adding  too  much  for  temperament,  or  we  may  not  have  discounted  enough 
for  symptoms.  As  these  are  the  only  two  points  where  judgment  is  used  the 
only  other  possibilities  are  clerical  mistakes  or  carelessness  in  making  the 
dynamic  tests.  Temporary  lenses,  approximating  the  correction  are  given 
together  with  such  instructions  as  the  analysis  dictates,  and  a  later  examina- 
tion is  made  under  better  conditions,  because  the  patient  will  not  only  im- 
prove physically  in  the  meantime,  but,  having  learned  that  the  process  is 
not  a  dangerous  one,  the  mentality  will  be  more  composed  for  the  second 
examination. 

An  important  feature  of  the  Neurometer,  exhibited  in  Table  1,  is  that 
theoretically,  no  glasses  will  be  needed  for  close  work  only  until  about  the 
thirty-fifth  year,  because  the  reserve,  after  accommodating  for  the  13-inch 
point,  is  as  much  as  is  being  used.  Practically,  when  the  additions  to  Table  1 
for  temperament  and  hyperopia,  when  the  latter  exists,  are  considered,  we 
find  that  no  person  under  45  years  will  ever  need  glasses  for  close  work  only. 
Those  who  ignore  errors  of  refraction  and  prescribe  glasses  for  near  work 
cannot  fail  to  cause  trouble  for  themselves  and  their  patients,  because  they 
do  not  touch  the  nerve  strain  produced  by  the  effort  to  overcome  the  errors ; 
they  only  save  a  very  small  portion  of  the  extra  demand  for  the  near  work. 

The  following  specimen  cases  will  contribute  to  a  detailed  understanding 
of  the  Neurometer,  and  the  more  it  is  used  the  greater  will  be  the  apprecia- 
tion of  it.  In  forming  an  opinion  with  reference  to  temperament,  we  must 
utilize  the  appearance  and  history  together  with  a  knowledge  of  physiog- 
nomical indications,  which  are  discussed  in  another  chapter: 

Case  I: — Male. 

Appearance:  About  5  ft.  8  in.;  well  proportioned;  155  pounds;  complexion, 
medium  (neither  blonde  or  brunette)  ;  smooth  face,  well  developed ; 
brown  hair  and  plenty  of  it,  parted  on  the  left  side;  intelligent  above 
the  average  ;  neat ;  healthy. 


162  A  SYSTEM  OF  MATURE  MEDICINE 

History:  Never  been  sick;  neither  smoked  nor  drank;  expert  accountant, 
worked  nine  hours  overtime  daily;  good,  practical  education;  normal 
interest  in  sports,  passing  events,  etc.,  but  no  fads ;  liked  good  literature  ; 
at  school  was  particularly  interested  in  mathematics,  geography,  his- 
tory and  business. 

Ophthalmoscope :  Vessels  numerous  and  of  good  calibre ;  contents  of 
arteries,  good  quality  and  quantity ;  veins  the  same ;  fundus  normal. 

Vision :    Normal  with  either  eye. 

Dynamics:    Near  point  5  inches,  8.00  diopters. 

Statics:    Red  and  white  lights  in  line,  O.  K. 

Correction :    None.     The  case  proved  to  be  emmetropic. 

Vision,  Dynamics  and  Statics,  same  as  at  first  test. 
Symptom  Classification: 

Appearance,  History,  Ophthalmoscope,  Dynamics,  Statics,  all  Good,  hence 

no  need  for  discounts. 
Analysis:...  Years     Months     Days 

Dynamics,  8.00  D 26  8  0 

Extra  work  and  temperament 12  0  0 


High   line    38  8  0 

Remarks:  An  unusual  case,  hence  20  per  cent,  was  added  to  the  max- 
imum for  temperament  in  lieu  of  adding  for  extra  work,  because  that  amount 
of  work,  while  developing  apparent  excess  accommodation,  is  not  conducive 
to  long  life  even  in  a  normal  person.  The  examination  and  analysis  were 
made  in  August;  the  subject  said  he  would  be  39  in  December. 

Case  II: — Female. 

Appearance:  Medium  height,  about  5  ft.  6  in.;  weight  about  110;  eyes 
blue ;  hair  light  brown  and  thin ;  complexion  below  normal,  indicating 
malnutrition ;  classification,  2,  between  20  and  35 ;  bust  development 
small ;  nose  pointed ;  lips  thin ;  medium  chin ;  ears  without  lobes ;  hair 
dressed  in  prevailing  fashion ;  clothes  neat  and  clean ;  hands  slender ; 
finger  nails  clean  and  polished;  no  jewelry;  average  intelligence; 
neither  pretty  nor  ugly ;  carriage  erect  and  evidently  in  fair  to  good 
condition,  comparatively,  that  is  for  one  who  applied  for  treatment. 

History :  Stenographer  and  bookkeeper,  working  eight  hours  daily ;  noth- 
ing congenital ;  no  infection ;  malnutrition  -indicated  by  indigestion, 
headaches,  constipation,  scant  menstruation,  deficient  appetite ;  no 
physical  shock ;  no  mental  shock ;  physiological  strain  from  evident  re- 
fractive error  and  probable  overtaxation  at  work ;  no  mental  strain, 
except  some  worry  because  she  had  not  found  relief  elsewhere ;  no  bad 
habits  save  wrong  eating;  occupation  rather  trying  at  times;  atmo- 
spheric conditions  such  as  are  common  in  city  offices,  with  improved 
conditions  at  home ;  lived  with  parents  in  suburbs. 

Ophthalmoscope :    Arteries   pale ;   veins   a    trifle   dark ;   vessels   small   but 

average  number;  fundus  pale. 
Vision  :   Normal  with  either  eye. 

Dynamics :   Near  point  4£  inches,  9.00  diopters. 


NEUROMETRIC  METHOD  OF  ANALYSIS  163 

Statics :  A  —  impulse  of  4  degrees. 

Correction:    L.+1.50;  R.+1.50. 

Vision :    Normal. 

Dynamics:    Near  Point,  3^  inches,  11.00  diopters. 

Statics :   A  —  impulse  of  1  degree. 

Pupillary  Distance  :    57  mm. 

Nose :    High,  3mm. ;  Base,  wide,  16  mm. ;  Crest,  back  3  mm. 

Size  of  lens :    0  eye ;  between  Lenses,  18£  mm. 

Temple  distance :   Medium,  6^  inches. 
Symptom  Classification:  Discount. 

Appearance,   Fair    3 

History,  Fair   3 

Ophthalmoscope,  Fair  3 

Dynamics,  Good   1 

Statics,  Medium    5 

Total  Points  12 

Per  Cent,  in  50  24 

Analysis:  Years  Months  Days  Years  Months  Days 

Dynamics,   11.00   D 17  6  0  17  6  0 

Hyperopia,     1.50  +     extra 

work  4  hours,  equals  .75  less  24%    3  5          24 

Hy.,  or  a  total  Hy.  2.25      470     less   12%    6  7  6 

Temperament,  B  —  7  6  0 

Condition    27  7  0 

High  Line  29  7  0  Year  Month  Day 

Safety  Line    25  6          2O     Date  of  Examination 1914        8        22 

Danger  Line 21  6          10     Patient  Born   1887        2          2 

Safety  Line    17  6  0 

Age   27        6        20 

Remarks :  Physiological  class  3.  This  patient  came  with  -|-1.50  pre- 
scribed for  near  work  only,  by  an  oculist.  We  ordered  them  worn  constantly, 
stopped  work  for  two  weeks,  changed  diet  habits.  At  the  end  of  a  month  all 
symptoms  had  disappeared,  she  looked  well,  felt  well,  registered  12.00 
dynamically  and  O.  K.  statically,  all  headaches,  constipation  and  other  dis- 
orders gone.  Taking  the  dynamic  showing,  which  indicates  15  years  and 
add  12  years  1  month  we  have  27  years  1  month  as  her  high  line  and  she  is 
a  trifle  above  it.  With  a  word  of  caution  we  let  her  go. 
CASE  III :— Male. 

Appearance  :  Height,  5  ft.  7  in. ;  weight,  140  ;  complexion,  dark  and  sallow  ; 
evidently  "grouchy";  something  lacking  in  youthful  opportunities  or 
training;  has  in  him  the  making  of  a  good  citizen. 

History:  Headaches  for  twelve  years;  dyspepsia;  dates  his  trouble  from 
beginning  to  wear  glasses,  but  can't  get  along  without  the  ones  used; 
was  dull  in  school  and  finally  quit  a  sixth  grade  because  he  couldn't 
get  along  with  teachers ;  burned  his  books  and  defied  his  parents. 
Exhibited  antipathy  to  doctors  while  being  questioned;  insisted  he 
knew  more  than  any..  I  stopped  right  here  and  settled  that  matter 
by  telling  him  to  go  to  the  devil  and  treat  himself;  or,  behave  him- 
self and  give  me  a  guaranty  of  decent  treatment  by  paying  my  fee  at 
once  in  advance.  He  cooled  down,  became  tractable  and  remained  in 
that  condition.  Occupation,  grocery  clerk. 


164  A  SYSTEM  OF  MATURE  MEDICINE 

Ophthalmoscope:   Vessels  abundant;  arteries  and  veins  in  good  condition, 

except  veins  a  little  too  dark ;  fundus  O.  K. 
Vision :   Very  bad,  20/200  each  eye. 
Dynamics  :   No  good ;  couldn't  register. 
Statics :   Normal. 

Correction:    Required  +7.00  each  eye.     Been  wearing  -f-5.50. 
Vision :   Normal. 

Dynamics :   Near  point,  4£  inches,  9.00  diopters. 
Statics :   Normal. 
Pupillary  Distance :    60  mm. 

Nose :   High,  3  mm. ;  Base  wide,  18  mm. ;  Crest,  back  3  mm. 
Size  of  lens,  00  eye;  between  lenses,  20  mm. 
Temple  distance,  7  inch. 

Symptom  Classification:  Discount 

Appearance,  Good    1 

History,  Good   ^ 1 

Ophthalmoscope,   Good     1 

Dynamics,   Good     1 

Statics,  Good  1 

Total  Points 5 

Per  Cent,  of  50  10 

Analysis:  Years  Months  Days  Years  Months  Days 

Dynamics,  9.00  D 23  4  0  23  4  0 

Uncorrected  Hy.  1.50  ....       7  6  0    less  10%  6          11  0 

Temperament,  B — 7  6  0    less     5%  7  1          15 

High   Line    38  4  0  Condition 37  4          15 

Safety  Line   33  4  0  Year  Month  Day 

Danger  Line    28  4  0  Date  of  Examination 1913        5        29 

Low  Line   .  23  4  0  Patient  Born   1876        3        19 


Age  37        2        10 

Remarks :    Physiological  class  3 ;  this  patient  is  an  illustration  of  how 

mental  conditions  contribute  to  the  disturbance,  reflexly,  after  the  physio- 
logical strain  has  set  up  the  original  irritation.    His  story  was  not  as  bad  as 
it  sounded.     We  got  his  final  correction  at  one  sitting  and  he  was  soon  a 
different  person. 
Case  IV: — Female. 

Appearance:    Height,  5  ft.  6  in.;  weight,  115;  brunette;  moody;  sallow. 
History:    Never  been  well  nor  happy;  found  fault  with  her  husband  and 
everyone  else,  unless  she  could  have  her  way ;  was  under  my  observa- 
tion for  three  weeks  before  examination;  indigestion  and  bad  dispo- 
sition.    Had  grief  periods  and  wailings. 
Ophthalmoscope :     Vessels    normal    size    and    calibre ;    number    normal ; 

arteries  pale;  veins  O.  JC. 
Vision:   Normal. 

Dynamics :    Near  point  5£  in.,  7.00  diopters. 
Statics :    A —  impulse  of  3  degrees. 

Correction :    Required  +2.00  each  eye.     Been  wearing  -(-1.25. 
Vision :   Normal. 


NEUROMETRIC  METHOD  OF  ANALYSIS  165 

Dynamics:    Near  point  4£  in.,  9.00  diopters. 
Statics :  A  —  impulse  of  3  degrees. 

Symptom  Classification:  Discount. 

Appearance,  Good 1 

History,  Fair   3 

Ophthalmoscope,  Good   1 

Dynamics,  Good   1 

Statics,   Bad   7 

Total   Points    13 

Per  Cent  of  50  '. 26 

Analysis:  Years  Months  Days  Years  Months  Days 

Dynamics,  9.00  D 23  4  0  23  4  0 

Uncorrected  Hy.  .75 8  9  0     less  25%    6  6          21 

Temperament  D—    5  0  0     less  12i% 4  4          15* 


High  Line  37  1  0                Condition 34            3            6 

Safety  Line   32  6  0                                                  Year  Month  Day 

Danger   Line    27  11  0  Date  of  Examination 1909        2          7 

Low  Line    23  4  0  Patient  Born   .                   . .  1874      11          2 


Age   34        3          5 

Remarks:  Physiological  class  4;  the  discount  figures  show  26  per  cent., 
but  for  convenience  I  sometimes  call  such  a  case  25  as  it  figures  easier.  In 
this  instance  it  figured  within  one  day  of  her  age.  Had  I  figured  the  26  and 
13  it  would  have  given  34 — 1 — 27,  putting  her  in  the  same  class. 

Case  V:— Female. 

Appearance :  Delicate ;  5  ft.  4  in. ;  weight  about  100 ;  blonde ;  actions  in- 
dicate a  nervous  temperament;  intelligent. 

History;  Dysmennorrhoea,  with;  flooding  every  three  weeks;  headaches; 
indigestion  and  bloating;  pains  in  the  back;  been  treated  medically 
but  never  operated,  although,  advised  that  was  the  only  help;  un- 
married because  she  realized  she  was  not  fitted  physically  for  that  re- 
lation ;  school  and  college  education,  but  did  not  graduate  from  college 
on  account  of  ill  health.  Eyes  inflamed,  with  granulation;  been  in 
the  care  of  oculists  who  used  silver  nitrate,  atropine  and  other  drugs, 
without  relief.  Appetite  irregular  and  morbid;  prefers  sweets  and 
starchy  foods;  lives  with  parents  and  assists  her  mother  in  household 
cares ;  they  keep  servants. 

Ophthalmoscope :  Vessels  few  in  number  but  of  fairly  good  size ;  arteries 
pale ;  veins  medium ;  fundus  pale ;  blood  quantity  below  normal. 

Vision :  L.  20/30 ;  R.  20/40. 

Dynamics :   Near  point  4  in.,  10.00  diopters. 

Statics :   A-f-  impulse  of  4  degrees. 

Correction:    Accepted  +1.50 — .75  axis  180;  R.+1.50 — 1.00  axis  180. 

Vision :   Normal. 

Dynamics :   Near  point  3|  in.,  11.00  diopters. 

Statics :    A+  impulse  of  3  degrees. 


166  A  SYSTEM  OF  MATURE  MEDICINE 

Symptom  Classification:  Discount. 

Appearance,   Fair    3 

History,   Medium    5 

Ophthalmoscope,  Fair   3 

Dynamics,  Good   1 

Statics,    Good     1 

Total    Points    13 

Per  Cent,  in  50   26 

Analysis:  Years  Months  Days  Years  Months  Days 

0  0 


Hyperopia  2.00  D  

.  .  .        5 

0 
6 

0 
0 

less  26%    

3             8           12 
669 

Temperament   B  —    .  .  . 

7 

less   13% 

High   Line    

..  .     27 

6 
4 
2 
0 

0 
0 
0 
0 

Condition 

25             2           21 
Year  Month  Day 

IQIO                C                    Q 

Safety  Line    

.  .  .     23 

•  Danger  Line    

.  ..      19 

Low  Line   

.  ..      15 

1  8RS           2             7 

Age    25         4  2 

Remarks :  Physiological  class  4.  The  dynamic  test  after  correction 
showed  only  1.00  diopter  increase,  when  it  should  have  been  at  least  1.50; 
the  static  test  showed  a  -(-  impulse  before  and  after  correction,  proving  we 
did  not  get  all  of  the  hyperopia;  therefore,  adding  -4-50  for  the  3  degrees 
spasm,  -{-2.00  spheres  were  prescribed,  regardless  of  vision,  for  temporary 
wear,  and  that  amount  was  added  to  her  first  dynamic  showing  to  get  the 
evident  dynamic  exhibit,  because  the  hyperopia  had  to  be  overcome  before 
starting  on  the  10.00  diopter  showing  at  the  first  test ;  ordered  rest ;  change 
of  diet ;  hot  baths  and  plenty  of  sleep ;  physical  exercise  at  monthly  periods ; 
cold  salt  water  as  a  collyrium ;  return  for  report  at  weekly  intervals.  At  the 
end  of  three  months  menses  were  regular  and  floodless ;  headaches  and  other 
symptoms  all  gone,  even  to  the  eye  granules ;  had  gained  six  pounds ;  reg- 
istered 13.00  with  final  correction  on;  L.+1.25+.75  axis  90;  R.-f  1.00+1.00 
axis  90 ;  static  test  O.  K. 

Case  VI :— Male. 

Appearance :  Tall ;  slender ;  delicate ;  face  and  hands  ashen  ;  black  hair  and 
eyes ;  intelligent ;  would  be  fine  specimen  if  well. 

History:  Indigestion,  etc.,  from  sedentary  habits;  occupation,  teacher  of 
phrenology ;  gave  many  free  lectures  when  he  should  have  been  on 
sick  leave ;  not  been  well  for  several  years,  but  never  consulted 
physicians;  only  came  to  me  because  one  of  my  pupils  and  his  friend 
insisted  on  an  examination.  Very  little  to  his  story  to  suggest  the 
condition  found.  Bad  eater. 

(  )phthalmoscope :  Vessels  large  and  numerous,  but  arteries  nearly  empty 
and  blood  away  below  normal ;  veins  dark  and  sluggish  ;  fundus,  dull. 

Vision:    Normal. 

Dynamics:    Near  point  10  in.,  4.00  diopters. 

Statics :    A —  impulse  of  10  degrees. 

Correction:    L.-J-1.25;  R.-f-l.oO;   R.  the  fixing  eye. 


NEUROMETRIC  METHOD  OF  ANALYSIS  167 

Vision :   Normal. 

Dynamics :    Near  point  6  in.,  6.50  diopters. 

Statics :   A —  impulse  of  10  degrees. 
Symptom  Classification:  Discount: 

Appearance,    Bad    7 

History,   Bad    7 

Ophthalmoscope,  Bad   10 

Dynamics,  Fair  3 

Statics,   Bad   10 

Total    Points    37 

Per  Cent,  of  50  74 

Analysis:  Years  Months  Days  Years  Months  Days 

Dynamics,  6.50  D 32  0  0  32  0  0 

Hyperopia  1.50  D 7  6  0     less  74%    1          11          12 

Temperament  A  -f-    12  0  0     less  37%    7  6          21 


High   Line    51  6  0  Condition    41  6  3 

Safety  Line   45  0  0  Year  Month  Day 

Danger  Line    38  6  0  Date  of  Examination 1903        5        20 

Low  Line   32  0  0  Patient  Born   .  . .  1862        6          3 


{  Age   40      11        17 

Remarks:    Physiological  class   7.     Close   to  his  danger  line   by  actual 

measurement,  taking  the  best  possible  view  of  the  case.  He  was  told  he 
must  stop  all  work  at  once  and  begin  a  series  of  most  careful  treatments,  as 
his  body  chemistry  was  bad  and  if  he  neglected  it  longer  it  would  grow  worse 
rapidly;  that  if  he  neglected  the  warning  he  would  die  inside  if  sixty  days 
and  would, exhibit  what  the  health  office  would  call  a  bad  case  of  smallpox, 
but  he  would  be  conscious  to  the  last  minute,  because  the  trunk  lines  to  his 
brain  were  able  to  carry  nourishment  there  but  the  lack  of  quantity  had  re- 
duced the  pressure  until  the  capillaries  of  the  body  generally  were  not  used, 
hence  the  skin  exhibit.  He  smiled  benignly  and  told  his  friend  later  that 
I  was  a  bright  man,  but  too  enthusiastic  over  my  Neurometer.  The  friend 
cautioned  him,  because  he  was  an  old-school  doctor  of  many  years  practice 
and  had  taken  the  course  with  us.  He  did  not  follow  instructions  and  died 
on  the  forty-fifth  day.  The  health  office  pronounced  it  smallpox  of  the 
most  virulent  type  and  quarantined  his  office  and  residence  for  two  days, 
when  they  heard  of  my  prognosis  and  withdrew  the  quarantine,  changing 
their  "diagnosis"  to  "neurasthenia."  His  widow  told  me  he  was  conscious 
to  the  last  minute  and  talked  to  her  up  to  an  hour  before  he  died. 

Case  VII:— Male. 

Appearance  :  Short ;  fat ;  happy-go-lucky ;  nervous  temperament ;  good 
color  and  would  be  called  well  by  all  except  those  of  us  who  know 
that  no  person  under  6  feet  tall  and  over  200  pounds  weight  can  be 
healthy,  Neurologically. 

History:  Good,  except  his  manner  of  living;  hearty  eater  and  considered 
himself  an  epicurean ;  a  Homeopathic  surgeon  with  a  big  practice  and 
overworked. 

Ophthalmoscope :    Good  showing,  except  blood  plethoric. 


168  A  SYSTEM  OF  MATURE  MEDICINE 

Vision :    Normal. 

Dynamics :    Near  point,  6  in.,  6.50  diopters. 

Statics:    A-J-  impulse  of  3  degrees. 

Correction :    L.  and  R.-J-.75. 

Vision :    Normal. 

Dynamics:    Near  point,  5|  in.,  7.00  diopters. 

Statics :   A-f-  impulse  of  5  degrees. 
Symptom  Classification:  Discount. 

Appearance,   Good    1 

History,    Bad     7 

Ophthalmoscope,   Fair     3 

Dynamics,  Fair   3 

Statics,  Good   1 

Total    Points    15 

Per  Cent,  of  50  30 

Analysis:  Years  Months  Days  Years  Months  Days 

Dynamics,  8.00  D 26  8  0  26  8  0 

Hyperopia  1.50  D 7  6  0     less  30%    5  3  0 

Temperament  A +......     12  0  0     less  15%    10  2          12 

High   Line    46  2  0  Condition    42  1          12 

Safety  Line   39  8  0  Year  Month  Day 

Danger   Line    33  2  0  Date  of  Examination 1903        3        16 

Low  Line  . .  26  8  0  Patient  Born   .  . .  1860        6          6 


Age   42        9        10 

Remarks :  Physiological  class  4.  The  bad  features  of  this  case  were 
that  his  nervous  tension  was  so  great  that  he  could  not  register  properly 
dynamically;  adding  .75  to  the  -J-.75  correction  accepted,  because  of  the  + 
impulse,  making  a  total  correction  of  1.50  needed,  and  adding  that  to  his  first 
showing  we  got  the  dynamic  8.00 ;  then  his  attitude  toward  our  methods  and 
toward  himself  told  us  he  would  not  follow  instructions  if  we  gave  them ; 
his  blood  pressure  was  great  and  the  sort  ofi  food  he  was  eating  tended 
to  reduce  the  resistance  of  the  vascular  walls.  There  was  nothing  to  do 
except  to  tell  him  we  understood  his  skepticism  and  took  no  offense  because 
he  evidently  intended  none ;  but,  we  did  tell  him  that  he  would  die  of 
"apoplexy"  within  three  years.  He  laughed,  slapped  me  on  the  back  and 
told  me  he  would  outlive  Methuselah's  record.  Two  and  a  half  years  later 
I  received  a  paper  from  his  home  town  announcing  his  death  from  "apoplexy" 
and  comment  was  made  on  the  fact  that  a  Chicago  doctor  had  told  him  he 
he  would  go  that  way  within  three  years.  Now  let  no  one  get  the  idea  that 
because  I  have  foretold  the  deaths  and  manner  thereof  in  some  cases  in 
advance  that  it  is  claimed  possible  to  do  it  all  the  time.  That  would  be 
foolish.  I  have  had  thousands  of  cases  and  have  only  had  comparatively 
few  such.  Happily  I  have  had  a  considerable  number  who  were  in  bad 
condition  but  followed  instructions  and  recovered.  It  is  a  coincidence  wor- 
thy of  note  that  in  not  a  single  instance  among  those  who  died  did  I  get  a  fee 
nor  would  I  if  they  had  followed  instructions,  as  they  were  all  friends  of 
myself  or  my  students  who  were  brought  to  the  college  as  clinics.  I  have 
found  that  those  who  are  concerned  enough  to  pay  a  fee  will  do  as  they  are 
told.  The  moral  is :  Always  get  a  fee. 


NEUROMETRIC  METHOD  OF  ANALYSIS  169 

These  specimen  cases  are  sufficient  to  show  that  no  two  cases  are  alike ; 
that  the  practice  of  true  ophthalmology  is  not  to  be  compared  with  the  work 
of  oculists  and  "optometrists,"  and  that  retinoscopy  is  a  joke. 

Important  features  of  the  Neurometer  are: 

First,  the  dynamic  test  after  approximate  correction  of  the  errors,  in- 
dicates a  certain  age  by  Table  1;  to  this  add  for  the  hyperopia  and  extra 
work,  if  there  be  any,  Tables  3A  and  3B,  and  the  total  will  indicate  the 
patient's  physiological  high  line.  If  his  actual  age  is  below  that  the  case 
will  be  found  near  the  danger  line  in  the  final  analysis. 

Second,  taking  the  total,  as  found  by  the  addition  for  dynamics  and 
hyperopia,  as  above,  and  if  the  real  age  is  above  it  the  difference  indicates 
the  temperament,  by  Table  4,  less  the  discounts  for  symptoms,  physiological 
and  temperamental.  For  example:  With  a  -\-  2.00  correction  a  patient 
registers  10.00  diopters  which  indicates  by  Table  1,  20  years,  0  months,  0 
days ;  to  this  is  added  5  years  for  hyperopia,  Table  3A,  making  25  years.  Pa- 
tient says  he  is  32,  a  difference  of  7  years,  hence  this  is  his  temperament, 
Table  4,  except  that  we  have  found  the  symptoms  indicate  a  discount  of  30 
per  cent,  physiologically  and  15  per  cent,  temperamentally,  therefore  7 
years,  plus  the  30  per  cent,  discount  from  the  5  years  added  for  hyperopia, 
is  only  85  per  cent,  of  his  real  temperament;  Thus,  7  years  plus  1  year  6 
months  is  8  years  6  months,  or  102  months ;  this,  divided  by  85  and  multi- 
plied by  100  gives  120  months,  or  10  years,  Class  A  as  his  normal  tempera- 
ment. 

Third,  when  the  condition  found  by  analysis  and  the  patient's  actual 
age  differ  more  than  a  few  weeks,  if  the  age  is  below  the  indicated  condi- 
tion we  prescribe  by  that ;  if  the  condition  indicated  is  lowest  we  prescribe 
accordingly,  thus  we  are  always  on  the  safe  side  for  both  patient  and  our- 
selves. 

Fourth,  If  a  patient  is  found  near  his  high  line  we  may  allow  considerable 
liberty,  unless  he  is  above  the  high  line,  when  rest  is  imperative.  If  near 
his  safety  line  advise  rest  for  a  week.  If  at  his  safety  line  or  below  it  order 
rest  and  refuse  the  case  unless  orders  are  obeyed  strictly.  If  near  the  danger 
line  an  ophthalmologist  may  prescribe  glasses  and  rest  but  should  also  send 
the  case  to  a  Neurologist. 

Fifth,  there  are  instances,  such  as  the  last  two  of  the  specimen  cases, 
where  there  are  special  reasons  for  regarding  the  situation  as  dangerous, 
even  when  the  patient  makes  a  pretty  good  showing  by  the  tests.  It  is 
only  by  training  in  physics,  anatomy,  physiology,  symptomatology,  analysis, 
dietetics,  metaphysics  and  prognosis  that  the  practitioner  is  able  to  attain 
skill  and  diplomacy  in  handling  such  cases. 

Sixth,  It  is  our  policy  to  exercise  care  with  even  the  most  ordinary 
cases,  in  order  to  form  the  habit ;  then,  while  we  do  not  believe  in  doing 
or  saying  anything  that  will  frighten  a  patient  unnecessarily,  we  can  not 
avoid  telling  the  truth  as  we  find  it  by  analysis,  and,  as  a  rule,  our  patients 
appreciate  the  fact  that  we  are  measuring,  not  guessing. 

Seventh,  The  fee  column,  Table  4  starts  with  100%  at  the  high  line. 
In  Neurological  cases  $100  is  the  indicated  fee.  In  ophthalmological  prac- 
tice it  is  less,  of  course,  and  it  is  left  to  the  practitioner  to  substitute  his 


170  A  SYSTEM  OF  MATURE  MEDICINE 

minimum  fee  in  this  place  and  the  others  will  adjust  themselves  according 
to  the  per  cents,  specified. 

Eighth,  the  addition  to  fees  for  disposition  is  an  important  matter.  Even 
Class  A  may  be  influenced  by  outsiders,  jealous  doctors,  or  just  fool  laymen, 
hence  this  is  a  reminder  to  look  out  for  that  and  protect  yourself  and  Nature 
by  getting  all  fees  in  advance  as  a  guaranty  instructions  will  be  followed. 
You  know  the  laws  will  work,  if  given  opportunities,  and  you  place  the 
responsibility  where  it  belongs — with  the  patient. 

The  very  best  feature  of  the  Neurometer  is  that  it  works  best  when  it 
doesn't  work.  By  which  statement  I  mean  that  if  a  patient  is  in  such  a 
state  of  nervous  disorder  that  our  analysis  develops  High,  Safety,  Danger, 
Low  lines  and  a  Condition  indication  at  variance  with  his  or  her  actual 
age  we  are  able  to  utilize  the  data  to  find  the  reason  for  the  showing,  the 
details  of  which  can  only  be  demonstrated  clinically ;  but  the  reader  need 
not  fail  to  profit  by  this  paragraph  because  such  a  showing  in  any  case 
tells  at  once  that  the  patient  needs  immediate  care,  temporary  correction, 
rest,  etc. 

If  a  patient  is  actually  older  than  the  years,  months  and  days  given  as 
his  High  line,  take  the  difference  and  subtract  it  from  his  high  line,  when  it 
will,  as  a  rule,  correspond  to  his  condition  showing.  It  means  that  his 
system  is  in  a  state  of  temporary  irritation  and  we  put  him  in  class  1, 
physiologically,  which  is  an  abnormal  state,  2  being  the  High  line  or  normal 
physiological  condition. 


CHAPTER  XIX. 

^ 

Cyclophoria  Often  the  Cause  of  Apparent  Oblique  Astigmatism. 

Cyclophoria  is  a  rotation  of  the  eye-balls  on  their  longitudinal  axes.  It 
is  of  two  varieties,  corresponding  to  the  -f-  and  -  -  impulses  described  else- 
where. The  first  is  produced  by  nervous  spasm  exhibited  through  the  in- 
ferior oblique  muscles.  The  second  is  nervous  exhaustion  exhibited  through 
the  same  muscles.  It  is  discoverable  only  when  there  is  astigmatism ;  many 
cases  of  apparent  oblique  astigmatism  are  due  entirely  to  it,  and  the  great 
discomfort  produced  by  lenses  prescribed  under  such  conditions  puzzled 
oculists  and  opticians,  many  of  whom  have  been  forced  to  regard  such  as 
"difficult"  cases. 

The  inferior  obliques  are  supplied  by  branches  of  the  third  nerves, 
hence,  when  the  efforts  to  overcome  hyperopia  have  so  reduced  the  supply 
that  the  general  nervous  system  has  become  irritated,  exhibiting  spasm  of 
accommodation  and  -f-  impulses  by  the  static  test,  it  is  only  natural  to 
expect  the  inferior  obliques  to  be  involved ;  sometimes  spasm  only  exhibits 
in  these  muscles,  because  the  other  branches  are  under  control,  and  it  is, 
therefore,  an  important  item  for  consideration  aside  from  the  fact  that  it 
presents  false  axes  for  the  astigmatism. 


Fig.  105  shows  in  solid  lines  the  normal  positions  of  the  vertical  and  hor- 
izontal meridians  of  the  two  eyes  as  they  would  be  seen  with  patient  facing 
the  operator.  With  a  spasm  of  the  nervous  system,  exhibiting  through  the 
inferior  obliques,  these  two*  principal  meridians  will  be  shifted  to  the  dashed 
lines,  and  the  test  may  show  the  deviation  to  be  anywhere  from  a  few  degrees 
to  as  much  as  thirty.  Whenever  such  a  case  is  found  the  proper  thing  to  do 
is  to  prescribe  temporary  spheres  and  order  rest  for  a  week,  when  it  will  be 
found  in  a  vast  majority  of  instances  that  upon  reexamination  the  two 
meridians  will  be  vertical  and  horizontal  and  the  patient  will  invariably 


A  SYSTEM  OF  MATURE  MEDICINE 


accept  more  -|-  sphere  in  the  correction  than  at  the  first  test,  thus  proving 
doubly  the  existence  of  spasm. 


Fig.  106  shows  the  reverse  condition,  from  nervous  weakness ;  the  supply 
being  deficient,  the  inferior  obliques  have  less  tension  and  the  natural  pull 
from  the  elasticity  of  the  superior  obliques  roll  the  eye-balls  inward  above 
so  that  the  principal  meridians  appear  as  the  dashed  lines,  the  amount  of 
deviation  being  regulated  by  the  amount  of  the  deficiency  of  course. 

As  has  been  shown  in  the  chapter  on  tri-curved  surfaces,  all  regular, 
nonspherical,  curved  surfaces  have  their  two  principal  meridians  always  at 
right  angles ;  hence  such  a  thing  as  regular  astigmatism  with  the  two  prin- 
cipal meridians  not  at  right  angles  is  an  impossibility.  It  is  also  a  fact 
that  in  all  toric  surfaces,  such  as  are  presented  by  all  astigmatic  eyes,  the 
secondary  principal  meridians  are  exactly  half  way  between  the  primary 
principal  meridians.  Thus,  the  primary  principal  meridians  being  at  vertical 
and  horizontal  positions,  the  secondary  meridians  will  be  at  45  and  135 
respectively.  The  anatomical  arrangement  of  the  rectus  muscles  is  such  that 
when  there  is  true  oblique  astigmatism  it  would  be  most  likely  to  have  its 
primary  principal  meridians  on  the  positions  of  the  secondary  meridians 
of  the  regularly  astigmatic  eyes,  because  of  the  vertical  and  horizontal  pull 
of  the  tension  of  the  recti  muscles. 


Fig.  107  shows  the  second  probable  position  of  the  principal  meridians 
and  the  positions  they  would  be  shifted  toward  in  cases  of  spasm.  I  had 
one  case,  a  student,  who  had  been  wearing  an  over-correction  of  compound 
myopia  with  the  axes  of  his  cylinders  at  L.  150;  R.  30.  He  had  worn  the 
lenses  a  long  time  and  exhibited  many  symptoms  of  hyperopia,  such  as 
irritability  of  temper,  headaches,  indigestion,  etc.  He  had  been  in  optical 
work  nearly  all  of  his  life  and  was  skeptical  when  told  that  he  was  a  hyperope 
with  his  glasses  on  and  that  he  must  be  cyclophoric  because  of  his  complaint 
that  object  appeared  distorted.  He  made  a  fine  clinical  specimen  for  the 
class  because  of  his  assurance  and  the  manner  in  which  he  was  handled.  No 
attempt  was  made  to  give  him  good  vision  at  first ;  but  he  was  given  lenses 


CYCLOPHORIA  AND  OBLIQUE  ASTIGMATISM 


173 


of  sufficient  power  to  enable  him  to  go  about  safely.  After  a  week  or  two 
we  went  over  the  case  again  and  secured  normal  vision  with  very  much 
weaker  lenses  than  he  had  been  wearing.  As  a  matter  of  precaution  I  re- 
moved the  astigmatic  charts  while  making  the  refraction  test,  in  order  that  we 
might  give  him  the  surprise  I  was  sure  was  coming.  His  principal  meridians 
were  vertical  and  horizontal  and  when  I  attempted  to  shift  the  axes  of  the 
cylinders  to  the  positions  in  which  he  had  been  wearing  them  he  set  up  a 
mighty  protest,  declaring  he  could  see  nothing.  It  was  very  evident  he 
thought  the  axes  were  in  the  same  old  place  and  that  I  was  trying  to  force 
them  to  my  chosen  position.  The  other  students  enjoyed  it  all  immensely. 
When  I  said  "Well,  if  you  must  have  the  axes  on  those  meridians  we  will 
have  to  let  you  have  them"  he  let  out  his  enthusiasm  over  my  supposed  de- 
feat. The  class  fairly  howled:  "Take  off  the  glasses  and  look  where  the 
axes  are."  He  was  rather  stunned  to  find  he  had  been  fighting  for  my 
position.  But  he  joined  the  laugh  on  himself  and  made  a  good  student. 


Fig.  108  shows  the  reverse  condition,  when  the  nerve  supply  is  weak. 
All  four  illustrations  are  products  of  nervous  conditions  exhibited  through 
third  nerves  and  the  inferior  obliques. 

I  do  not  mean  to  say  there  is  never  oblique  astigmatism  with  the  prin- 
cipal meridians  at  other  positions  than  the  four  meridians  given;  but  there 
is  so  much  danger  in  prescribing  oblique  cylinders  when  the  meridians  are 
not  at  45  and  135  that  it  is  safe  practice  to  proceed  with  care  and  temporary 
spherical  lenses.  There  are  instances  of  high  amounts  of  astigmatism  in 
which  the  axes  are  at  other  meridians ;  but  in  the  lower  amounts,  where  it 
is  not  sufficient  to  impair  vision  greatly,  cyclophoria  will  be  developed  as  the 
cause  of  the  unusual  axes  in  nearly  all  cases. 

Lest  some  reader  assumes  I  have  forgotten  something  I  will  add  that 
no  treatment  is  needed  other  than  the  temporary  spheres  and  rest  until  the 
nerve  supply  is  reinforced.  It  is  the  same  with  all  other  so-called  "muscle 
troubles,"  even  to  cross-eyes,  as  I  shall  show  in  another  chapter. 

We  do  not  need  any  tests  for  cyclophoria  because  we  are  after  the 
Causes.  One  of  the  old-school  oculists  proposed  a  test  as  follows : 

"The  eye  under  examination  should  be  covered  and  the  Maddox  double- 
prism  placed  before  the  other  eye.  A  card  on  which  a  horizontal  line  is 
drawn  is  held  18  inches  from  the  eyes,  and  the  patient  fixes  upon  the  line, 
when  two  lines  are  perceived  by  the  action  of  the  prism ;  then  the  cover  is 
removed  from  the  other  eye  and  three  lines  are  seen,  the  third  or  new  line 
being  between  and  parallel  to  the  other  lines  if  orthophoria  is  present.  If 
there  is  any  imbalance  of  the  oblique  muscles,  the  third  line  will  be  tilted 


174 


up  or  down  obliquely."  He  says  if  the  nasal  end  tilts  down  it  means  weak- 
ness of  the  superior  oblique  muscle,  and  if  it  tilts  up  it  indicates  weakness 
of  the  inferior  oblique  muscle. 

There  are  two  weak  spots  in  his  proposition :  The  first  is,  of  course, 
the  fact  that  the  muscle  is  not  at  fault,  because  its  actions  all  depend  on  the 
nerve  supply.  The  second  is  that  if  the  vertical  meridian  of  the  eye  was  the 
one  of  greatest  power,  what  he  says  would  happen  would  be  true ;  but  if,  as  is 
sometimes  the  case,  the  horizontal  meridian  had  the  maximum  curve,  the 
reverse  would  happen.  Again,  the  two  lines  seen  by  the  eye  wearing  the 
double-prism  would  not  be  at  all  likely  to  appear  horizontal,  unless  there 
was  no  astigmatism,  because  like  all  other  "muscle  troubles,"  it  is  nerve 
trouble  and  both  eyes  would  exhibit  it. 

They  have  "clinoscopes,"  "cyclophorometers,"  "cyclo-duction"  and  other 
"tests,"  with  mystery  galore.  They  operate  and  prescribe  prisms !  The 
latter  proposition  suggests  cork-screws  to  me  so  forcibly,  I  cannot  refrain 
from  recommending  them  instead  of  the  prisms.  They  would  certainly  be 
as  consistent  with  common  sense. 

They  remind  me  of  one  Gould,  compiler  of  dictionaries,  who  in  col- 
laboration with  "L.  Webster"  Fox,  once  perpetrated  the  following  "bull"  in 
a  quiz  compend : 

"Astigmatism  is  an  invisible  and  elusive  imp  of  mischief,  requiring 
much  patience  and  keenness  to  hunt  him  down.  His  hiding  place  is  the 
ciliary  muscle;  his  disguise,  amblyopia.  He  hates  atropia  as  his  father  was 
said  to  hate  holy  water." 

Now,  anyone  who  knows  anything  about  physical  optics  and  eyes  gen- 
erally, knows  that  astigmatism  is  not  an  "invisible,  elusive  imp" ;  that  it 
requires  no  "patience  to  hunt  him  down" ;  although  it  does  require  some 
skill,  but  not  nearly  so  much  as  is  required  to  get  all  of  the  hyperopia.  Any 
competent  Ophthalmologist  knows  that  instead  of  a  "disguise,"  amblyopia 
is  the  thing  that  exposes  the  astigmatism,  and  he  knows  that  astigmatism 
is  not  affected  one  whit  by  atropine.  The  whole  story  is  crooked,  clear  down 
to  the  "holy  water." 

Don't  let  anyone  deceive  you  about  cyclophoria,  reader.  Whenever  you 
find  oblique  astigmatism,  practice  the  temporary  lens  and  building-up-the- 
nervous-system  method ;  you  will  win  all  the  time. 


CHAPTER  XX. 

Physiological  Action  of  Prisms,  with  Proofs  of  Their  Unvalue. 

L 


1 

1 

1 

. 

I 

r 

t 

fc 

1 

1 

* 

1 

% 
1 

1 

1 

Take  a  piece  of  white  paper  four  feet  long  and  with  an  ordinary  black 
crayon  draw  a  diagram  after  Fig.  109,  making  the  vertical  lines  four  inches 
apart;  have  a  small  candle  or  electric  light  in  front  of  the  line  L.  Then 
seat  a  person  fifteen  or  twenty  feet  from  the  light;  put  on  the  trial  frame; 
adjust  it  so  the  patient  looks  through  the  centers  of  the  cells;  cover  the 
right  eye  with  the  black  disc;  put  the  plane  red  glass  in  the  cell  behind  it; 
put  the  double-prism  on  the  left  eye  and  adjust  it  so  two  white  lights  are 
seen,  one  directly  above  the  other ;  uncover  the  right  eye  and  the  red  light 
should  be  seen  in  line  with  the  two  white  ones  and  half  way  between  them. 
As  a  general  rule  this  indicates  normal  balance  of  the  nervous  distribution 
and  is  known,  with  reference  to  the  eyes,  as  orthophoria,  meaning  correct 
tending.  Any  deviation  will  exhibit  a  displacement  of  the  red  light  and 
it  is  termed  heterophoria ;  but  it  is  subdivided,  according  to  the.  location  of 
the  red  light,  into  esophoria,  inward  tending;  exophoria,  outward  tending; 
hyperphoria,  upward  tending;  cataphoria,  downward  tending;  hyper- 
esophoria,  upward  and  inward  tending;  hyper-exophoria,  upward  and  out- 
ward tending;  cata-esophoria,  downward  and  inward  tending;  cata-ex- 
ophoria,  downward  and  outward  tending. 

We  do  not  use  the  terms  above  described,  in  order  to  avoid  confusion. 
If  the  red  light  is  seen  to  the  left  it  is  a  +  impulse ;  if  to  the  right  it  is  a 
—  impulse ;  if  above  or  below  the  center,  but  in  line,  it  is  —  or  — ,  the  dot 
locating  the  position  of  the  red  light  above  or  below  the  center ;  if  above 
the  center  and  to  the  right  or  left  it  is  indicated  — •-  or  _^;  if  below  and  to 
right  or  left  it  is— r  or^— •;  the  latter  deviations  mean  an  erratic  distribution 
of  the  nerve  supply. 

We  never  prescribe  prisms  for  such  symptoms  any  more  than  we  would 
prescribe  hypodermic  injections  of  morphine  for  pain  or  internal  medicines 
for  corns.  We  will  show  plenty  of  good  reasons  why  Nature  is  leading  us 
aright  while  the  self-styled  "authorities"  are  persisting  in  wrong-doing  be- 


176  A  SYSTEM  OF  MATURE  MEDICINE 

cause  they  are  ignorant  of  Physics,  of  Anatomy,  of  Physiology  and  hence, 
necessarily,  of  Therapy. 

To  ascertain  the  physiological  value  of  prisms,  take  as  a  subject  one 
who  is  practically  emmetropic  and  orthophoric,  and,  when  he  has  fixed  on 
the  diagram,  seeing  two  with  the  double  prism  on  left  eye,  place  a  4-degree 
prism,  base  out,  before  the  right  eye,  then  uncover  it  by  removing  the  black 
disc;  have  him  locate  the  position  of  the  red  light  with  reference  to  the 
numbers  on  the  left  end  of  the  chart;  now  remove  the  trial  frame  and  have 
him  hold  two  strings,  one  under  the  center  of  the  pupil  of  each  eye ;  have  an 
assistant  take  the  other  ends  and  hold  them,  the  one  from  the  left  eye  on 
the  line  L  where  it  crosses  the  horizontal  line  and  the  other  on  the  hori- 
zontal line  at  the  point  designated  by  the  patient  as  the  point  where  the  red 
light  appeared;  these  strings  represent  the  two  axes  of  the  eyes  and  the 
point  where  they  cross  each  other  will  be  found  approximately  1  meter  from 
his  face.  This  is  the  angle  of  convergence  caused  by  the  prisms,  and  re- 
quires a  convergent  movement  of  .50  diopters  by  each  eye.  Theoretically 
this  brings  with  it,  automatically,  1.00  diopter  of  accommodation  in  each. 
Practically,  the  capacity  for  adaptability  prevents  this  from  exhibiting  in 
all  instances,  but  emmetropes  have  always  exhibited  a  decided  dimness  of 
vision  on  the  letter  chart  when  a  2-degree  prism  was  placed  before  each  eye, 
thus  proving  the  theoretical  proposition ;  and  even  others  who  see  pretty 
well  with  the  prisms  on,  over  their  corrections,  soon  complain  of  the  strain, 
adding  corroboration  to  the  emmetropic  showing.  Therefore,  taking  the  4- 
degree  exhibit  as  a  basis,  we  have: 

For    convergence : . . .  /  L.     .50 

Automatic  >  T  '  .,'QQ 

Accommodation <  D'  ./_„ 

^  K.   1.00 

Total 3!00 

Figuring  by  the  second,  as  in  other  calculations,  we  have : 

3X60X60X16  =  172,800  units  demand  per  day  of  16  hours,  or  43,200 
units  per  degree,  up  to  the  limit  of  capacity  of  the  patient  to  adapt  himseH 
to  them  and  see  singly  with  the  two  eyes.  The  average  capacity  for  prisms 
in  this  position  is  about  20-degrees,  or  864,000  units  daily,  or  the  equivalent 
of  3.75  diopters  of  hyperopia.  It  is  not  remarkable  then  that  the  prism 
fiends  found  that  patients  would  not  "tolerate"  strong  prisms,  nor  that 
Maddox  says  in  his  book  on  prisms,  page  28,  that  4-degrees  is  the  maximum 
prism  to  be  used,  no  matter  what  the  degree  of  "muscular  error." 

If  the  prisms  are  placed  bases  in,  the  demand  is  altogether  on  the  sixth 
nerves,  which  have  no  other  nerves  associated  with  them,  so  only  the  .50 
divergent  pull  by  each  eye  is  needed,  hence,  theoretically,  the  demand  is 
only  one-third  as  much  as  when  the  prisms  are  base  out;  but,  inasmuch  as 
we  did  not  charge  anything  for  the  evident  strain  through  other  branches 
of  the  third  nerves,  with  prisms  in  the  first  position,  we  have  placed  the 
demand  for  bases  in  at  one-fifth  as  much  as  for  bases  out ;  this  gives  strain 
as  8,640  per  degree,  and  the  limit  of  capacity  is  about  8-degrees. 

For  prisms  base  up  or  down  the  demand  is  on  the  third  nerves  again, 
and  while  it  has  not  been  possible  to  measure  the  strain  exactly  we  have 


PHYSIOLOGICAL  ACTION  OF  PRISMS  177 

estimated  it  at  one-third  as  much  as  if  base  out,  or  14,400  units  per  degree, 
with  a  capacity  limited  to  about  4-degrees. 

Now  take  any  person  who  exhibits  deviation  by  the  test,  but  who  holds 
his  eyes  in  line  when  the  test  is  removed,  so  that  he  sees  singly,  the  effect 
of  prisms  would  certainly  be  identically  the  same  as  for  the  emmetropic 
and  orthophoric  person.  Even  an  "oculist"  or  "optometrist"  ought  to  see 
that  clearly. 

I  have  been  practicing  on  this  proposition  nearly  twenty-five  years 
with  uniform  success  and  I  have  yet  to  prescribe  my  first  prism  for  "  'phoria." 
It  is  only  one  of  the  many  symptoms  patients  exhibit  to  prove  the  strain 
is  from  the  effort  to  overcome  the  error  of  refraction.  I  have  had  hundreds 
of  cases  where  prisms  had  been  prescribed,  some  with  very  bad  effects, 
others  with  slightly  bad  effects,  others  with  no  apparent  effects  and  others 
with  "good"  effects.  I  was  interested  to  learn  the  reason  for  this  variety, 
admitted  by  the  prescribers  and  attested  by  the  victims.  Investigation 
yielded  fine  results.  One  case  of  "good"  results  is  worth  giving  in  detail: 

Away  back  in  1895  one  of  my  former  pupils  came  into  the  school-room 
one  day  and  proudly  announced  that  he  had  seen  my  prism  story  knocked 
into  a  cocked  hat  by  a  correspondence  graduate  ffom  Dr.  Allen's  "school." 
His  cousin,  a  young  lady,  who  had  16  degrees  of  "esophoria"  had  been 
"cured"  of  12  degrees  of  it  in  one  month  by  a  pair  of  2-degree  prisms  base 
out.  That  was  a  stunner  ;  but  as  it  came  from  a  man  who  had  been  a  farmer 
and  graduated  as  a  horse  doctor  after  drenching  a  horse  once,  became  a 
druggist  and  jeweler  by  purchasing  a  store,  and  a  photographer  because  he 
sold  kodaks,  I  had  the  impertinence  to  ask  him  for  a  bill  of  particulars.  He 
produced  the  prescription.  Here  it  is  : 

R.-J-2.50,  2-degree  prism  base  out. 
O,  2-degree  prism  base  out. 


Then  I  went  for  him.  He  had  been  taught  in  my  school  how  to  figure 
the  strain  from  hyperopia,  and  was  giving  credit  to  the  prism  for  the  good  ef- 
fects when  it  was  very  evidently  due  to  the  -4-  2.50  spherical  len'ses  ;  but 
like  a  great  many  others  who  have  been  taught  the  truth  and  had  it  proved 
to  them,  he  preferred  to  accept  the  bluffer's  story  —  until  after  I  had  finished 
with  the  "following  explanation.  The  strain  on  the  patient,  uncorrected,  was  : 

t-        A  L.  2.50 

ror  Accommodation  :   ..............  -p    «  59 

Automatic  Convergence  :   ...........  :~ 

IV.       I  ..-•' 

Negative  pull  6th  nerves  :   .......  L-  1-25 

R.  1.25 
Total  .......................  ?    10.00X60X60X16  =  576,000  units, 

all  of  which  was  saved  by  the  lenses,  making  patient  an  emmetrope,  pro- 
vided 2.50  was  the  total  amount  of  hyperopia.  Then  putting  the  prisms  on 
caused  a  strain  of  172,800  units  daily,  which,  deducted  from  the  576,000  saved 
by  the  lenses,  left  a  net  saving  by  the  lenses  of  403,200,  in  spite  of  the  prisms. 
That  was  why  the  prisms  did  "good"  in  that  case.  He  saw  the  point  and 
came  over  to  my  side  at  once.  Then  I  knocked  him  down  with  the  follow- 
ing proof  that  the  prisms  really  did  good  in  that  case  : 


178  A  SYSTEM  OF  MATURE  MEDICINE 

I  proposed  that  we  consider  the  patient  a  hyperope  of  3.50,  because  I 
knew  no  Allen  graduate  ever  came  within  a  diopter  of  a  correction;  there- 
fore the  strain  would  be: 

For  Accommodation :   L.  3.50 

R.  3.50 
Automatic  Convergence :   L.  1.75 

R.  1.75 

Negative  pull  6th  Nerves :   L.  1.75 

R.  1.75 

Total 14.00X60X60X16  =  806.400  units. 

Of  this  amount  576,000  was  saved  by  the  +  2.50  spheres  prescribed, 
leaving  a  hyperopia  of  1.00  diopter  uncorrected,  necessitating  the  strain : 

For  Accommodation :   L.  1.00 

R.  1.00 

Automatic  Convergence :   L.    .50 

R.     .50 

Negative  Pull  6th  Nerves  :   L.     -p ° 

R.     50 


Total     4.50 ;  but,  the  2-degree  prisms  bases  out, 

made  the  .50  convergence  in  each  eye  a  necessity,  while  the  accommodation 
took  care  of  the  hyperopia  so  no  negative  pull  was  needed ;  thus  the  prisms 
actually  saved  one-fourth  of  the  day's  strain  from  the  uncorrected  error,  or 
57,600  units;  a  total  saving  by  lenses  and  prisms  of  633,600  out  of  the  total 
strain  of  806,400,  leaving  a  balance  of  172,800  strain  which  could  be  saved 
by  leaving  the  prisms  out  and  adding  -)-  1.00  to  the  lenses.  He  went  home 
and  made  a  test  by  our  methods,  found  the  hyperopia  3.50,  prescribed  it  and 
in  a  week  all  the  "muscle  trouble"  was  gone. 

Incidentally  it  may  be  remarked  that  for  any  amount  of  hyperopia  trie 
prism  which  will  necessitate  the  convergent  pull  which  is  due  automatically 
with  all  efforts  of  accommodation,  will  save  one-fourth  of  the  strain  caused 
by  the  error.  Anything  else  will  cause  trouble,  either  by  adding  to  the 
strain  or  not  saving  as  much  as  could  be  done  with  the  right  prism.  But  who 
is  fool  enough  to  relieve  one-fourth  of  the  strain  with  prisms  when  he  can 
relieve  it  all  with  the  correction  in  full?  If  2-degrees  on  each  eye  will  save 
one-fourth  of  the  strain  on  a  hyperope  of  1.00  all  that  is  necessary  to  find 
the  prism  for  any  amount  of  hyperopia  is  to  multiply  2  by  the  number  of 
diopters  of  hyperopia  in  the  fixing  eye  and  put  that  much  prism  on  each  eye. 

Even  if  there  is  a  diplopia  it  does  not  mean  prism  or  operation.  It 
means  that  the  patient  is  in  such  a  state  of  spasm  or  weakness  that'  abso- 
lute rest  is  needed.  And,  let  me  remark  here,  either  exhibit  is  proof  of 
insufficient  nerve  supply;  but  the  spasm  indicates  nearer  a  normal  supply 
than  weakness  does.  See  the  chapter  on  cross-eyes. 

Now  we  come  to  another  side  of  the  story.  I  am  almost  ashamed  to 
tell  it.  If  it  had  not  been  proved  so  positively  and  in  so  many  ways  I  would 
keep  quiet : 

The  "accepted  authorities"  did  not  and  do  not  know  Physics,  Anatomy, 
or  Physiology.  First,  they  declare  that  when  the  lights  deviate  in  one  direc- 
tion the  eyes  deviate  in  the  opposite  one.  As  a  physical  proposition  this 
could  not  be  true  and  both  eyes  see  equally  well.  Physiologically,  all  that 
is  necessary  to  prove  it  false  is  to  take  a  case  that  sees  the  red  light  to  the 
right  and  drop  a  prism,  base  out,  in  front  of  it,  when  it  will  turn  in  per- 


PHYSIOLOGICAL  ACTION  OF  PRISMS  179 

ceptibly,  proving  it  must  have  been  turning  out  before,  and  proving  that 
if  their  claim  was  true  the  turning  in  of  the  eye  would  put  the  light  farther 
to  the  right,  which  it  does  not  do  but  does  the  contrary.  They,  evidently, 
never  watched  the  eye,  but  assumed  that  because  a  prism  breaks  rays  to- 
ward its  base  and  the  eye  sees  through  the  prism  in  that  position  it  is  proof 
the  eye  turned  in;  they  forget  that  the  eye  saw  before  they  put  the  prism 
on  as  well  as  after,  hence  must  have  adapted  itself  to  the  new  arrangement. 
Therefore,  what  they  call  esophoria  is  really  exophoria;  what  they  call 
exophoria  is  esophoria ;  what  they  call  right  hyperphoria  is  left  hyperphoria, 
etc.  In  short,  the  eyes  deviate  in  the  same  direction  the  lights  do  in  all  cases 
of  'phoria.  Note  that  I  say  eyes;  for  they  are  wrong  a  second  time  when 
they  declare  one  eye  alone  does  the  deviating.  Never.  Try  this  experi- 
ment: Have  a  subject  take  a  10  or  20-degree  prism  and  hold  it  base  out 
in  front  of  his  right  eye,  the  other  being  closed,  and  you  will  see  the  eye 
turn  toward  the  nose  decidedly;  now  have  him  open  both  eyes  and  repeat 
the  performance  on  the  right  eye,  but  you  watch  the  left  and  you  will  see 
it  turn  first  toward  the  left,  with  its  fellow,  but  immediately  it  will  con- 
verge with  a  jerk  and  he  will  tell  you  he  sees  singly;  now,  have  him  remove 
the  prism  suddenly  when  the  right  will  turn  out  to  its  normal  position  while 
the  other  will  first  turn  in,  then  let  loose  its  convergence  and  turn  out  to  its 
position.  If  you  want  any  better  proof  that  both  eyes  turn,  come  to  me  per- 
sonally and  I  will  supply  more — it  couldn't  be  better.  Third,  after  "diag- 
nosing" and  declaring  prism  treatment  would  do  the  work  and  finding  it 
failed,  of  course,  they  resorted  to  operation  and  "graduated  tenotomies" 
became  a  great  fad,  until  the  oculists  became  involved  in  damage  suits; 
then  they  stopped  with  suddenness  and  one  very  prominent  man  in  New 
York  told  a  friend  of  mine  that  prisms  and  operations  are  no  good  be- 
cause he  had  tried  them  and  found  it  out.  Yet  he  talked  and  wrote  against 
"empirics."  Fourth,  and  worst  of  all,  they  did  not  and  do  not  know  that 
muscles  are  only  the  mediums  through  which  nervous  energy  is  applied, 
hence  their  talk  about  "muscle  troubles."  If  they  knew  anything  of  anatomy 
and  physiology  they  would  not  expose  themselves ;  this  is  the  only  reason 
I  have  not  denounced  them  individually  as  criminals  for  their  operations  and 
prism  "exercises."  Ask  any  prescription  house  and  you  will  be  informed 
there  is  not  one  prism  prescription  comes  in  now  in  proportion  to  twenty- 
five  a  few  years  ago.  That  is  the  final  proof  of  my  contention.  When  I 
published  my  little  primer,  "Optical  Truths"  in  1898,  their  "eminences" 
declared  I  was  a  number  one  fool.  But  I  had  the  truth  and  could  prove  it. 
I  got  my  story  from  Nature,  not  from  alleged  "authorities."  My  ex- 
periences have  taught  me  to  advise  my  pupils  that  the  greater  the  "author- 
ity" the  more  watching  he  needs., 

Another  hobby  of  the  "oculists"  and  their  imitators,  the  "optometrists," 
is  the  "Duction  Test"  of  the  Muscles : 

Adduction  is  caused  by  placing  prisms,  bases  out,  before  the  eyes  and 
finding  the  strongest  a  patient  can  overcome  with  his  internal  recti  and  see 
a  light  singly  at  fifteen  or  twenty  feet.  The  "rule"  is  that  if  the  interni  can- 
not overcome  at  least  20  degrees  prism  they  are  too  weak  and  their  an- 
tagonists, the  externi,  must  be  cut;  but  if  they  overcome  more  than  24  de- 


180  A  SYSTEM  OF  MATURE  MEDICINE 

grees  they  are  too  strong  and  must  be  cut.  Imagine  a  muscle  too  strong,  if 
you  can. 

Abduction  is  produced  by  placing  prisms,  bases  in,  before  the  eyes  and 
finding  the  strongest  the  externi  can  overcome  and  maintain  single  vision. 
The  minimum  is  6  and  the  maximum  8  degrees,  and  the  penalties  are :  if 
the  externi  are  too  weak  their  antagonists,  the  interni,  must  be  cut;  but  if 
they  are  too  strong  they  have  to  be  knifed. 

Sursumduction  is  effected  by  placing  prisms,  base  up  on  one  eye  and 
down  on  the  other,  to  test  the  capacities  of  the  superior  and  inferior  recti ; 
the  minimum  is  3  and  the  maximum  4  degrees ;  penalties  similar  to  the  others. 

An  amusing  feature  in  this  connection  is  that  in  cases  where  the  so- 
called  "muscle  test"  with  double  prism,  or  Maddox  rod  and  the  colored 
glass  shows  "exophoria,"  a  weakness  of  the  interni,  according  to  them,  the 
Duction  test  always  shows  the  same  muscles  too  strong;  and  when  the  same 
test  shows  "esophoria,"  or  too  strong  interni,  the  duction  test  proves  them 
too  weak.  More  proof  that  their  'phoria  story  is  the  reverse  of  what  they 
claim.  "It  is  to  laugh." 

The  "optometrist"  is  not  authorized  by  "law"'  to  operate,  hence  he  pre- 
scribes prisms,  as  do  also  some  oculists.  But  if  either  were  required  to 
demonstrate,  theoretically  or  practically,  the  physical  or  physiological  value 
of  prisms  they  could  not  do  so,  even  were  their  lives  at  stake. 

Another  fad  is  the  "Dot-and-Line"  Test.  They  take  a  small  card  and 
make  a  dot  on  it,  place  the  double  prism  before  one  eye,  the  other  being 
covered,  and  have  the  patient  find  two  dots,  in  a  vertical  position ;  then  when 
the  other  eye  is  uncovered  it  sees  a  third  dot.  If  it  is  exactly  in  the  middle 
of  the  space  between  the  other  two,  the  eyes  are  o.  -k. ;  if  the  third  dot  is 
seen  on  the  left  by  the  right  eye,  they  say  that  eye  is  turning  out ;  if  it  is  seen 
to  the  right,,  the  eye  is  turning  in.  In  the  first  instance  it  is  said  to  be  from 
weakness  of  the  interni,  and  in  the  second  it  is  weakness  of  the  externi.  Then 
they  make  a  second  test  with  a  line  drawn  through  the  dot,  when,  in  many 
cases  the  third  dot  is  seen  on  the  line  when  it  was  not  in  that  position 
before,  because  the  right  eye  had  something  to  guide  it  to  the  place.  As  a 
matter  of  fact  the  test  is  all  bosh,  because  the  muscles  are  not  being  tested 
at  all.  It  is  merely  their  voluntary  nerve  supplies  which  are  being  tried 
and  the  symptoms  are  interpreted  wrongly,  because:  First,  both  eyes  are 
equally  involved :  second,  in  the  first  instance  the  supply  to  the  interni 
exhibited  strongly  on  account  of  having  no  guide  to  tell  when  to  stop  con- 
verging, and  it  means  a  good  supply,  while  the  outward  deviation  is  because 
the  nerve  supply  is  too  weak.  They  have  the  foolish  idea  that  the  objects 
seen  by  the  eyes  in  this  and  also  in  the  "muscle  test"  deviate  in  a  direction 
opposite  to  that  taken  by  the  eyes,  when  the  reverse  is  true,  as  we  have 
shown  elsewhere. 

One  thing  few  prism  writers  and  users  know  is  that  the  angle  of 
deviation  caused  by  a  prism  is  only  about  one-half  as  many  degrees  as  the 
prisms  used.  The  exact  amount  may  be  found  by  multiplying  the  degrees 
of  prism  by  the  excess  index. 


CHAPTER  XXI. 


Heterophoria,  "Muscular  Insufficiency,"  a  Nervous  Exhibit.    Treatment. 

Othophoria   means  correct  tending  of  axes. 

Heterophoria  means  incorrect  tending  of  axes. 

Esophoria  means  convergent  tending. 

Exophoria  means  divergent  tending. 

Hyperphoria  means  one  axis  tends  above  the  other. 

Hyper-esophoria  means  a  compound  tending. 

Hyper-exophoria  means  a  compound  tending. 

Cyclophoria  may  be  present  with  either  of  the  above  or  alone.  ("See 
special  chapter  on  it.) 

An  alleged  "authority"  says :  "We  must  confess  that  our  knowledge 
as  regards  muscular  asthenopia  and  insufficiency  of  convergence  is  still  in 
its  infancy.  The  nature  of  this  affection  is  still  obscure,  and  trustworthy 
observations  of  the  results  of  operations,  with  a  view  to  cure  it,  have  been 
neither  numerous  nor  in  accord  with  each  other."  Then  he  indulges  himself 
in  a  long  dissertation  on  "the  absolute  or  relative  weakness  of  the  adductors 
or  upon  their  insertion." 

Not  a  word  about  nerves.  There  is  a  reason  for  this.  It  is  to  be  found 
in  the  following  diagram : 


Xatural 


Therapy. . 


Artificial 


(Air  

Nitrogen  

Chemical.  .  .  . 

Oxygen  
Water  

McCormic 

Salts  

Medical 

Baths  

Mechanical.  . 
(  Drugs  

Physiological  .  .  . 
("Prevention".  .  . 

Exercise.  .  .  . 
Systemic.  .  .  . 
Mental  
"Vaccine".  .  . 
"Antitoxins" 

College 
Methods 
The 

"Cure"  ... 

"Specifics".  . 

il....  • 
Surgery  , 

{Commercial  

"Tonics".  .  .  . 
Individual.  .  . 
Trust  

Old 
School 

Necessary  

Repairs  

Relief.. 

Methods 

There  is  a  duality  in  therapy  as  in  all  other  matters.  The  two  legs  are 
Natural  and  Artificial.  The  old  schools  are  addicted,  hopelessly  it  appears, 
to  the  latter.  Neurology  is  founded  upon  the  former. 

The  old  schools  have  their  "muscle"  test,  their  "duction"  test,  their 
"dot-and-line"  test.  The  first  is  the  same  as  our  Static  Nerve  Test,  that  is 
the  double  prism  or  Maddox  rod  on  one  eye  and  a  colored  glass  on  the  other. 
But  they  do  not  use  it  correctly. 


182  A  SYSTEM  OF  MATURE  MEDICINE 

First,  they  assume  that  if  the  red  glass  is  on  the  right  eye  and  the 
red  light,  at  fifteen  or  twenty  feet  distant,  is  seen  at  the  right,  it  indicates  an 
inward  tending  of  the  right  eye,  from  weakness  of  its  external  rectus  muscle, 
when,  as  a  matter  of  fact,  this  is  absolutely  false  in  every  particular.  Both 
eyes  are  tending,  both  are  tending  outward,  and  it  is  not  from  muscular 
weakness,  but  is  from  a  weak  general  nerve  supply,  exhibiting  through  the 
internal  recti  of  both  eyes.  It  is  not  an  "affection"  any  more  than  headache 
is  an  "affection."  It  is  a  symptom  to  guide  us  toward  a  cause. 

Second,  if  the  red  light  is  seen  at  the  left,  they  "diagnose"  the  right 
eye  is  turning  out,  from  weakness  of  its  internal  rectus.  This  is  wrong. 
Both  eyes  are  turning  in,  from  nervous  irritation,  spasm,  exhibiting  through 
the  internal  recti.  This  exhibit  is  always  accompanied  by  tonic  spasm  of 
accommodation  which  conceals  much  of  the  hyperopia.  This  is  easily  proved 
by  using  strong  plus  spheres  as  temporary  lenses,  together  with  rest,  sleep, 
baths,  etc.,  until  the  general  nerve  supply  is  built  up  and  the  spasm  breaks 
down,  when  the  "exophoria"  (really  esophoria)  is  gone  and  even  "esophoria'' 
(really  exophoria)  is  exhibited  sometimes,  while  the  plus  lenses  accepted, 
with  normal  vision,  are  often  several  times  as  strong  as  at  the  first  test. 

They  are  equally  wrong  in  "hyperphoria"  and  the  compound  "affec- 
tions." To  be  right  the  student  should  reverse  all  of  their  statements  as  to 
the  direction  of  deviation,  and  remember  that  both  eyes  are  always  involved, 
that  it  is  not  "muscle  weakness"  in  either  instance,  but  is  spasm  of  the 
nervous  system  in  convergence,  weakness  of  the  same  in  divergence,  and  an 
erratic  distribution  in  the  compound  exhibits,  due  to  irritation  or  weakness 
of  the  nerve  supply,  a  matter  to  be  settled  by  other  symptoms. 

Their  "duction"  test  was  devised  by  the  "commercial"  surgeon  who  was 
so  eager  to  operate  for  the  fee  that  when  the  "muscle"  test  showed 
orthophoria  he  could  still  find  an  excuse  for  operating. 

This  test  comprises  "adduction,"  "abduction,"  "sursumduction."  The 
first  consists  of  placing  prisms,  bases  out,  before  the  eyes,  the  patient  looking 
at  a  digtant  light,  and  if  he  can  overcome  20,  or  up  to  24  degrees,  and  see 
singly,  his  internal  recti  are  all  right ;  but  if  he  cannot  overcome  as  much  as 
20  degrees,  the  "muscles"  are  too  weak,  and  the  externi  must  be  cut.  If  he 
can  overcome  more  than  24  degrees  and  see  singly  his  interni  are  too  strong 
and  must  be  cut.  The  second  test  is  with  prisms,  bases  in,  or  toward  the 
nose,  and  the  test  is  on  the  externi,  their  minimum  is  6  and  maximum  8  de- 
grees ;  if  they  are  below  6  the  interni  must  be  cut,  and  if  they  overcome  more 
than  8  degrees  the  externi  must  be  cut.  The  third  test  is  for  the  superior 
and  inferior  recti,  and  one  prism  is  base  up,  the  other  base  down ;  if  the 
muscles  under  the  apexes  of  the  prisms  cannot  overcome  as  much  as  3  de- 
grees, their  antagonists  must  be  cut,  and  if  they  overcome  more  than  4  de- 
grees they  must  be  cut. 

It  is  easy  to  see  how  prolific  a  source  of  revenue  such  a  "test"  can  be 
made.  When  the  student  tries  the  "muscles"  in  this  manner  and  finds  how 
they  can  be  trained  to  adapt  themsleves  to  almost  any  amount  of  prism, 
base  out,  and  that  the  "abducting"  and  "sursumducting"  range  is  very 
limited;  then  considers  the  normal  daily  demands  for  each,  respectively,  it 


HETEROPHORIA  A  NERVOUS  EXHIBIT  183 

will  be  easy  to  see  why  the  author  quoted  had  to  report  that  "trustworthy" 
observations  have  "not  been  in  accord  with  each  other." 

I  once  had  in  my  class  a  physician  who  showed  such  weakness  at  each 
of  the  three  tests  that  the  indications  were  all  of  the  "antagonists"  would 
have  to  be  cut.  I  wrote  one  of  the  enthusiastic  "professors  of  duction  tests" 
and  inquired  respectfully  which  muscles  should  be  cut.  He  did  not  reply. 
I  didn't  cut  any  and  the  doctor  is  all  right  to  this  day.  The  fact  was  the 
man  was  presbyopic  and  growing  old,  hence  could  not  have  exhibited  up  to 
any  youthful  standard  of  nervous  demand. 

Third,  if  the  first  two  "tests"  fail  them  they  have  the  "dot-and-line" 
scheme,  which  is  a  dot  on  a  card,  held  a  few  inches  from  the  face,  the  double 
prism  on  the  left, eye,  the  other  being  covered,  and  when  the  prism  eye 
sees  two  dots,  vertically,  the  other  one  is  uncovered,  and  if  the  dot  seen  bv 
it  is  at  the  left  of  the  others,  the  convergence  is  weak,  so  the  externi  must 
be  cut;  but  if  it  is  at  the  right,  convergence  is  too  strong  and  the  interni 
must  be  cut.  There  is  a  saving  possibility,  however,  in  a  second  test  with 
a  line  drawn  through  the  dot;  then,  when  the  second  eye  is  uncovered,  if 
it  sees  three  dots  on  one  line,  no  cutting  is  needed,  but  if  the  single  dot  and 
line  are  at  the  left,  it  is  "insufficiency"  of  the  interni,  and  if  at  the  right 
it  is  "insufficiency"  of  the  externi. 

The  whole  test  is  a  farce,  and  they  are  wrong  again  in  their  "diagnosis," 
(which  means  two  guesses.)  When  the  left  eye  has  fixed  on  the  two  dots  at 
close  range,  both  eyes  are  converging,  as  can  be  seen  readily;  but  the  cov- 
ered eye,  having  nothing  to  guide  it,  converges  too  much,  if  the  patient  is 
young  and  vigorous,  so  that  when  the  eye  is  uncovered  it  sees  the  dot  out 
of  line  at  the  left,  or, .if  old  or  weak,  it  will  not  converge  enough  and  will 
appear  at  the  right,  just  the  reverse  of  what  they  "diagnose."  Then,  when 
the  line  is  added,  a  vast  majority  will  adjust  their  eyes  at  once  to  all  three 
dots  on  one  line,  because  the  controlling  center  in  the  brain  has  something 
to  guide  it  in  stopping  convergence  at  the  right  place.  If  there  is  an 
irritated  nervous  system  the  left  eye  will  see  two  dots  on  its  line  and  the 
right  will  see  one  dot  on  another  line,  at  the  left;  or  if  there  is  weakness 
it  will  see  its  line  and  dot  at  the  right.  But  in  no  instance  is  there  any 
warrant  for  operation  or  "prism  exercise;"  they  are  all  symptoms  of  causes 
which  are  to  be  found  in  errors  of  refraction  primarily,  and  in  several  pos- 
sible contributing  ones,  secondarily. 

The  various  "phorometers"  are  all  based  on  these  alleged  principles, 
hence  are  worse  than  worthless,  because  they  mislead  a  class  of  practitioners 
who  will  not  read  this  book  until  the  Christian  adopts  "The  Age  of  Reason" 
as  his  rule  and  guide,  and  the  "Christian  Science  Healer"  has  ceased  to 
chase  "material"  dollars. 

Operations  for  heterophoria  are  criminal.  Prism  exercises  are  foolish, 
and  prescribing  prisms  in  correcting  glasses  is  a  display  of  ignorance  of 
anatomy,  physiology,  physical  laws  and  ophthalmology  generally  which  is 
disgraceful. 

The  true  Ophthalmologist  learns  his  business,  Theoretically  and  Prac- 
tically. Then  he  is  able  to  find  causes  and  remove  them  without  drugs, 


184  A  SYSTEM  OF  MATURE 'MEDICINE 

operations,  prisms,  or  any  other  nonsense.  Nature  will  do  the  rest  if 
patients  will  afford  the  opportunity  under  proper  instructions. 

Our  static  test  is  solely  for  finding  the  state  of  the  nervous  system  by 
putting  the  eyes  in  such  a  situation  that  the  controlling  center,  in  the  brain, 
is  not  in  command;  then  the  exhibit  is  an  involuntary  one  and  is  fairly 
reliable.  However,  we  do  not  reach  final  conclusions  without  further  tests, 
which  are  described  in  their  proper  place;  and,  after  having  completed  our 
analysis  we  have  never  found  any  reason  for  prescribing  prisms  or  opera- 
tions. We  would  as  readily  prescribe  headache  powders  for  cases  exhibit- 
ing that  symptom. 

I  know  it  stirs  up  the  wrath  of  the  old-line  practitioners  -to  be  criticized, 
but  when  it  is  so  easy  to  prove  they  are  wrong,  and  to  prove  by  their  own 
works  that  they  have  merely  reiterated  one  another's  assertions,  evidently 
without  making  any  critical  tests  of  the  propositions,  it  becomes  a  necessity 
to  expose  them.  The  little  fish  who  ape  the  "authorities"  are  even  more 
virulent  than  the  big  ones — they  are  the  "optometrists"  who  have  been  made 
"professional"  people  in  a  night  by  acts  of  legislatures.  My  sympathy  is 
with  the  public. 

We  are  all  liable  to  errors,  which  are  pardonable;  but  to  put  assertions 
against  mathematics  is  foolish,  hence  unpardonable. 


CHAPTER  XXII. 

Heterotropia,  Strabismus,  Squint,  Cross-Eyes.     Treatment  Therefor. 

Orthotropia  means  eyes'  axes  parallel  at  rest. 

Heterotropia  means  eyes'  axes  crossed. 

Esotropia  means  convergent  axes. 

Exotropia  means  divergent  axes. 

Hypertropia  means  one  axis  up,  one  down. 

Hyperesotropia  means  a  compound  turning. 

Hyperexotropia  means  a  compound  turning. 

Normally  the  eyes,  when  at  rest,  or  in  their  static  condition,  have  their 
axes  parallel.  This  is  orthophoria,  also  orthotropia.  When  they  are  not 
parallel  it  is  heterophoria  or  heterotropia ;  the  former  if  the  deviation  is 
imperceptible  to  the  observer,  the  latter  when  the  turning  is  apparent. 

Cross  eyes  mean  crossed-  axes,  and  it  is  the  only  correct  term  to  use. 
The  several  names  in  the  title  of  this  chapter  and  to  be  found  in  books 
are  merely  "scientific"  expressions  for  use  by  those  who  cover  a  lot  of 
ignorance  with  a  lot  of  bluff. 

If  the  axes  turn  toward  each  other,  horizontally,  it  is  convergence;  ii 
they  turn  from  each  other,  horizontally,  it  is  divergence;  if  they  turn  up 
and  down  but  neither  toward  nor  from  each  other  it  is  hypervergence ;  if  they 
turn  toward  each  other  and  up  and  down  it  is  hyperconvergence ;  if  they 
turn  from  each  other  and  up  and  down,  it  is  hyperdivergence.  The  first 
three  are  simple  turns,  the  first  exhibiting  nervousi  irritation  through  the 
third  nerves  branches  to  the  interni ;  the  second  exhibiting  nervous  weakness 
through  the  same  channels;  the  third  may  be  spasm,  or  weakness  of  .the 
nervous  system  and  it  is  exhibiting  through  the  third  nerves  and  the 
superior  and  inferior  recti.  The  last  two  are  compound  turns:  the  first  of 
which  indicates  nervous  irritation  because  of  the  inward  turn,  but  a  ten- 
dency to  weakness  because  df  the  up  and  down  turns,  while  the  second  in- 
dicates weakness  because  of  the  outward  turn,  but  a  tendency  to  spasm 
because  of  the  up  and  down  turns. 

There  is  no  difference  of  opinion  between  this  writer  and  others  in  the 
matter  of  "diagnosing"  the  'tropias  generally,  because  even  they  can  see 
the  eyes  are  turning  in,  out,  up  or  down.  But  in  the  details  there  is  a  chasm 
as  big  as  the  Grand  Canyon  of  Arizona. 

"Authorities"  define  strabismus  as:  "That  abnormality  of  the  eyes  in 
which  the  visual  axes  do  not  meet  at  the  desired  objective  point  in  conse- 
quence of  incoordinate  action  of  the  external  ocular  muscles."  Then  they 


186  A  SYSTEM  OF  MATURE  MEDICINE 

subdivided  the  matter  into  classification  as  follows :  "Alternating,  one  in 
which  either  eye  fixes  alternately;  Concomitant,  one  in  which  the  squinting 
eye  has.  full  range  of  movement;  Convergent,  one  in  which  the  squinting 
eye  is  turned  to  the  nasal  side;  Divergent,  one  in  which  the  squinting  eye 
is  turned  to  the  temporal  side ;  Paralytic,  one  due  to  paralysis  of  one  or 
more  muscles ;  Spastic,  one  due  to  spastic  contraction  of  an  ocular  muscle." 
They  say,  only  one  eye  turns,  usually,  that  hyperopes  have  convergence ; 
myopes  have  divergence ;  that  operation  by  advancement  or  by  tenotomy 
is  the  only  treatment;  that  paralysis  is  one  cause,  amblyopia  another,  a 
lack  of  equilibrium  between  accommodation  and  convergence  another.  They 
have  a  plan  for  "orthoptic"  training  at  a  "reasonable  fee"  per  train  to  "pre- 
pare" patients  for  the  operation  or  to  find  how  much  cutting  is  needed. 

The  same  general  denunciation  applied  to  them  in  the  chapter  on 
heterophoria  applies  here.  There  is  but  one  exception,  and  that  is  obvious 
to  any  intelligent  person :  when  there  is  divergence  and  one  eye  is  blind  an 
operation  is  permissible  and  even  advisable — for  appearance. 

We  insist  that  the  primary  cause  of  all  cases  of  convergence  is  hyperopia, 
the  accommodation  effort  to  overcome  the  error  is  the  secondary  cause  and 
systemic  conditions  are  contributing  causes.  In  quite  a  number  of  cases  the 
latter  act  suddenly,  as  in  the  convulsions  of  whooping  cough  or  other  spasm- 
exciting  derangement,  or  the  same  suddenness  may  be  caused  by  weakness 
from  acute,  nerve-weakening  derangements  as  the  fevers.  That  amblyopia 
causes  it  we  deny.  Of  course  if  an  eye  is  amblyopic  its  connection  with  the 
controlling  centers  in  the  brain  is  not  such  as  well  tend  to  make  it  act  co- 
ordinately  with  the  other,  hence  it  might  be  imagined  a  cause  of  the  turn- 
ing; but  that  is  not  true  because  not  only  do  emmetropes  with  one 
injured  eye  not  have  cross  eyes,  but  ametropes  with  crossed  eyes,  one  being 
amblyopic,  straighten  by  our  method  almost  as  readily  as  if  there  was  no 
amblyopia.  The  first  case  I  straightened,  twenty-four  years  ago,  was,  and 
is  today,  amblyopic  to  the  extent  he  couldn't  differentiate  between  a  cow  and 
a.  street  car  with  the  bad  eye.  As  strange  as  it  may  appear  that  boy  grew 
up,  took  an  old-school  course,  and  is  a  rear  rank  member  of  the  Medical 
Trust  today.  But  his  bum  eye  remains  a  testimonial  to  Neurology. 

Divergence  is  often  the  result  of  operation  for  convergence;  sometimes 
from  a  general  weakness  of  the  nervous  system,  exhibited  through  the  third 
nerves  and  interni,  and  accompanied  by  weak  accommodation  and  other 
symptoms.  It  might  come  to  a  myope,  but  it  would  be  very  rarely  and 
with  contributing  causes  of  importance.  As, in  convergence,  hyperopia  is 
the  primary  cause,  accommodative  effort  the  secondary  one,  with  the  other 
possibilities  as  contributing  causes.  Hypervergence  is  accounted  for  in  the 
same  manner  and  by  the  probability  of  intra-vascular  obstruction  putting 
pressure  on  a  nerve  sufficiently  to  shut  off  the  current  to  superior  or  inferior 
muscles. 

As  in  the  'phorias  both  eyes  turn.  The  reason  one  exhibits  it  all, 
usually,  is  that  if  the  victim  permitted  both  to  remain  converged  or  diverged 
or  hyper  verged  he  would  see  double  and  have  difficulty  in  seeing  clearly 
because  the  images  would  neither  be  on  corresponding  points  of  the  two 
retinae  nor  would  they  be  near  the  centers  of  the  maculae,  hence  would  be 


CROSS  EYES  AND  TREATMENT  187 

very  indistinct.  Therefore,  in  order  to  see  clearly  he  fixes  with  one  eye  and 
forces  the  other  to  do  all  of  the  turning.  This  is  easily  illustrated  in  a  nor- 
mal pair  of  eyes.  Have  such  a  person  hold  a  finger  one  foot  from  the  eyes 
and  it.  will  be  noted  that  he  converges  with  both;  now  take  hold  of  his 
finger  and  pull  it  over  until  it  is  in  such  a  position  one  eye  is  looking  straight 
away  on  its  normal  static  line  and  the  other  will  be  seen  doing  all  of  the 
convergence  for  the  finger  distance.  In  cross  eyes  the  person  is  merely 
looking  at  a  distant  object  with  the  fixing  eye  and  the  other  is  exhibiting  ail 
the  turning  of  both.  Or  take  a  cross  eyed  person  and  have  him  fix  with  the 
eye  the  others  say  is  turning  and  you  will  see  a  reversal  that  proves  our 
story. 

When  a  case  is  presented,  no  matter  which  classification  it  belongs  to, 
we  first  cover  the  fixing  eye  and  ask  the  patient  to  fix  with  the  other,  with- 
out turning  his  head.  If  he  can  do  it  we  are  ready  to  proceed  at  once.  If 
he  cannot  we  put  on  temporary,  -}-  3.00,  bi-convex  lenses,  direct  that  they 
be  worn  constantly,  and  that  he  make  frequent  efforts  to  use  the  non-fixing 
eye;  we  may  even  order  a  patch  worn  over  the  fixing  eye;  hot  baths,  rest, 
proper  foods,  rotary  exercises  of  the  eyes,  separately  and  together,  stoppage 
of  all  close  work,  plenty  of  out  door  exercise.  After  he  can  fix  with  either 
eye  at  will  the  battle  is  half  won;  next  he  will  begin  to  see  double;  then  is 
the  time  to  let  down  a  little  on  the  fogging  to  encourage  the  controlling  cen- 
ters to  work.  In  some  cases  several  changes  of  lenses  are  necessary  during 
the  period  of  treatment ;  but  that  is  one  of  the  things  we  are  paid  for. 

The  reason  for  the  failure  of  our  imitators  in  this  work  is  their  ignorance 
of  the  laws  governing  such  matters  and  it  is  not  possible  to  give  them  in  a 
book;  it  must  be  done  clinically;  but  two  points  can  be  made  emphatic, 
namely:  They  do  not  correct  all  of  the  hyperopia,  and  they  do  not  know 
how  to  find  the  contributing  causes.  As  each  case  has  its  own  peculiarities 
in  the  latter  respect  it  can  be  seen  how  impossible  is  the  proposition  to  de- 
scribe them  here. 

Our  procedure  is  the  same  for  convergence  and  hypervergence.  For 
divergence  we  fog  the  fixing  eye  the  most,  as  in  other  cases,  but  we  under- 
correct  the  non-fixing  eye  a  little  leaving  enough  hyperopia  to  set  up  some 
accommodation  and  convergence,  unless  the  patient  is  too  weak ;  then  we 
would,  of  course,  build  up  the  system  first  in  the  usual  Neurological  manner, 
after  which  the  rest  is  easy,  except  in  the  rare  cases  of  divergent  squint  with 
one  eye  amblyopic,  when,  if  we  could  not  develop  vision  enough  to  help  us, 
we  would  not  continue  treatment.  In  all  such  cases  patients  are  told  of 
the  odds  against  them  at  once. 

In  the  matter  of  fees:  It  is  worth  $100.00  to  straighten  a  pair  of  cross 
eyes  and  anyone  who  does  it  for  less  beats  himself.  Those  who  get  more 
earn  it  if  the  person  is  able  to  pay  it  and  appreciates  what  it  is  worth  to  him. 
Some  patients  will  say:  "I  can  have  an  operation  for  $50.00."  We  reply: 
"You  ought  to  get  it  free,  or  at  most  for  $5.00,  because  it  only  requires  two 
minutes  of  the  surgeon's  time  and  you  take  all  the  risk  of  cocaine  poisoning, 
of  blood  poisoning  from  other  causes,  of  failure,  and  you  have  nothing  to 
protect  you.  The  oculist  will  not  guarantee  a  cure,  neither  will  he  guarantee 
you  against  harm.  We  will  do  the  latter.  He  will  not  pay  any  attention 


188 


to  your  general  condition,  which  is  often  a  very  important  feature.  We 
take  weeks,  sometimes  mcmths,  to  get  patients  in  shape.  If  the  oculist's 
clip  is  worth  $50,  our  method  is  worth  $5,000. 

It  is  a  crime  to  cut  the  muscles  when  only  the  nervous  system  is  at 
fault.  The  use  of  prisms  is  foolish  because  they  have  no  possible  chance  to 
work.  It  would  be  as  intelligent  to  give  medicine  to  straighten  the  eyes. 
Some  rascals  have  advertised  to  straighten  cross  eyes  with  "oils."  etc.,  and 
people  took  the  bait.  Barnum  made  a  famous  remark  which  applies  to  all 
such,  both  advertiser  and  victims. 

We  offer  a  rational  proposition,  and  we  feel  that  we  and  our  graduates 
are  entitled  to  remuneration  commensurate  with  the  value  of  our  services. 


The  Ophthalmoscope. 


A   Pterygium. 


A  Central  Cataract 


CHAPTER  XXIII. 

Alleged  "Diseases"  of  the  Eyes.     Their  Causes  and  Treatment. 

So-called  eye  "diseases"  are  given  great  amounts  of  space  in  the  text 
books,  and  alleged  text  books,  which  they  do  not  merit.  In  every  one  of 
them,  while  we  find  abundance  of  "therapy"  in  the  form  of  nitrate  of  silver, 
sulphate  of  zinc,  mercury  preparations  galore,  atropin,  leeches,  and  opera- 
tions for  which  it  is- frequently  admitted  they  have  no  reason,  we  find  noth- 
ing whatever  about  errors  of  refraction  as  even  possible  causes.  The  oculist 
has  gone  mad  on  "infections"  with  "bacilli"  as  causes,  and  he  has  about  fifty- 
seven  varieties  of  the  latter. 

It  is  the  purpose  here  to  eliminate  as  much  of  that  stuff  as  possible. 
Unfortunately,  we  have  to  refer  to  some  of  it  in  order  that  our  readers  may 
know  what  others  mean  when  they  refer  to  the  various  conditions  by  the, 
names  the  writers  have  given  them. 

The  very  fact  that  so  many  of  these  alleged  "diseases"  have  been  pro- 
nounced incurable  by  the  authors  referred  to  is  sufficient  practical  evidence 
that  they  must  be  wrong  in  their  diagnoses.  Theoretically  we  have  the  evi- 
dence that  all  ills,  save  those  which  come  from  injuries,  are  due  to  a  com- 
paratively limited  number  of  causes.  Speaking  generally,  all  possible  causes, 
including  accidents,  may  be  classified  under  ten  headings :  congenital, 
infection,  malnutrition,  physical  shock,  mental  shock,  physiological  strain, 
mental  strain,  habits,  occupation,  atmospheric  influences.  While  some  eye 
troubles  may  be  congenital,  some  from  infection,  and  some  from  physical 
shock,  at  least  ninety  per  cent  of  them  are  products  of  physiological  strain, 
due  to  the  effort  of  accommodation  to  overcome  hyperopia. 

We  shall  undertake  to  prove  by  the  following  pages,  and  the  practices 
of  the  readers  thereof,  that  the  books  referred  to  are  wrong,  that  the  applica- 
tion of  drugs  is  dangerous,  and  that  the  persistent  practices  of  oculists  along 
old  lines  is  conclusive  evidence  that  they  are  either  so  dogmatic  they  do  not 
want  to  learn  or  so  criminally  commercial  that  they  cling  to  willful  mal- 
practice for  the  dollars  there  are  in  it.  We  shall  show  that  graduates  from 
our  school,  and  others  who  employ  the  methods  described  herein,  have  a 
wider  field  of  practice,  hence  a  more  liberally  remunerative  one,  because  they 
are  taught  to  take  into  consideration  not  only  the  effects  of  errors  of  re- 
fraction upon  the  eyes  themselves,  but  upon  the  general  system ;  and  they 
are  also  taught  how  systemic  disorders  may  be  contributing  causes  to  eye 
troubles  when  the  errors  of  refraction  are  the  principal  cause.  We  shall 
show  that  by  giving  attention  to  both  classes  of  causes  we  accomplish,  with- 


15)0  A  SYSTEM  OF  MATURE  MEDICINE 

out  drugs  or  operations,  not  only  what  oculists  have  failed  to  do,  but  what 
general  practitioners  have  been  baffled  by.  Among  these  are  such  general 
disorders  as  amenorrhoea,  dysmenorrhoea,  menorrhagia,  indigestion,  con- 
stipation, skin  eruptions,  headaches,  and  a  great  many  other  nervous  de- 
rangements. 

It  is  our  contention  that  the  human  body,  and  all  of  its  parts,  present 
Natural  chemical  and  mechanical  problems  by  reason  of  derangements  and 
disorders ;  but  we  have  been  unable  to  find  any  reason  why  we  should  em- 
ploy artificial  chemical  combinations  at  all,  and  we  find  very  few  occasions 
when  it  is  necessary  to  resort  to  operation.  Our  successful  practice  for  over 
twenty-five  years  has  demonstrated  to  our  satisfaction  that  our  theory  is 
correct.  We  have  no  dogmas,  nothing  but  our  philosophy  (love  of  truth)  to 
guide  us,  and  we  have  learned  to  trust  it  implicitly.  This  does  not  mean 
guessing  at  a  proposition  and  calling  it  natural.  We  figure  on  everything 
and  do  not  accept  it  until  we  have  proved  every  point  by  our  double  check 
system,  which  prevents  the  possibility  of  error. 

Eye  disorders  are  of  several  classes.  First  we  have  the  external  exhibits. 
Second,  the  internal  ones.  Again  we  have  those  in  which  the  symptoms 
are  acute,  with  inflammation  externally  and  pain  internally.  Again  we  have 
the  external  swellings,  as  puffing  of  the  lids,  and  growths,  such  as  tumors 
and  pterygiums.  W.e  have  those  accompanied  by  painful  vision,  and  those 
which  are  not  so  attended.  We  have  those  in  which  there  is  internal 
vascular  dilation,  and  those  with  a  decided  deficiency  of  blood  supply.  The 
internal  exhibits  are  studied  through  a  knowledge  of  the  anatomy  and 
physiology  of  the  eyes,  and  with  the  aid  of  the  ophthalmoscope. 

'  Our  treatment  may  be  given  in  advance  for  all  conditions :  First,  we 
give  at  least  temporary  correction  of  errors  of  refraction  by  putting  on 
more  -f-  sphere  than  is  needed  in  all  cases  where  we  are  unable  to  approxi- 
mate the  exact  correction ;  second,  in  cases  of  external  inflammation  or 
symptoms  of  internal  ones  we  order  absolute  rest  from  all  close  work,  and 
direct  the  patient  to  remain  in-doors  where  the  temperature  is  even,  sleep 
as  much  as  possible,  apply  hot  water  to  the  face,  and  even  take  hot  all-over 
baths  if  possible,  followed  by  the  instillation  of  cold  salt  water,  (about  a 
heaping  teaspoonful  of  salt  to  a  glass  of  water),  if  the  inflammation  is  external ; 
third,  we  regulate  the  habits  of  diet,  and  particularly  the  use  of  intoxicants 
and  tobacco.  Fourth,  we  give  instructions  to  return  when  the  inflammation 
is  reduced,  or  the  pain  subsides,  which  should  be  in  about  a  week — pos- 
sibly less. 

Slight  injuries  to  the  eyes  should  be  let  alone,  except  to  remove  any 
foreign  particles  that  get  under  the  lids,  and  remain  in-doors  until  they  heal, 
using  salt  water  injections  and  keeping  the  eyes  closed.  A  laceration  of  the 
conjunctiva  will  heal  in  a  few  hours  if  let  alone.  For  the  more  severe  in- 
juries patients  should  be  sent  to  hospitals  where  they  can  have  surgical  care, 
and  let  those  in  charge  assume  responsibilities  we  do  not  care  to.  It  is  no 
credit  to  any  practitioner  to  lose  a  case,  and  our  universal  success  is  assured 
by  our  refusing  all  cases  where  we  are  not  sure  we  can  win.  We  are  per- 
fectly willing  to  accord  praise  to  the  orthodox  surgeon  who  exhibits  skill 


ALLEGED  EYE  DISEASES  1U1 


enough  to  save  even  the  stump  of  an  injured  eye,  so  that  an  artificial  one 
will  be  scarcely  noticeable. 

The  eye  lids  are  formed  by  the  tarsal  cartilages.  They  include  the 
orbicularis  palpebrarum,  the  tensor  tarsi  and  the  levator  palpebrae  superioris ; 
they  contain  the  Meibomian  glands  and  the  ducts  therefrom  which  pierce 
the  tensor  tarsi,  having  about  thirty  openings  on  the  edge  of  the  upper  lid 
and  half  as  many  below ;  they  are  lined  by  the  delicate  membrane,  the  con- 
junctiva, which  also  covers  the  front  of  the  eye  ball.  The  third  nerves,  which 
operate  the  accommodation  and  nearly  all  eye  muscles,  also  control  the 
openings  of  the  Meibomian  ducts,  and,  in  the  excessive  labor  required  by 
hyperopia  the  entire  nervous  system  becomes  irritated,  over-heated,  cramped, 
and  this  spasm  extends  to  these  ducts,  interfering  with  the  discharge  of  the 
sebaceous  matter,  or  salve,  which  is  secreted  by  the  Meibomian  glands, 
so  that  the  edges  of  the  lids  become  dry  and  scaly;  or  there  may  develop 
cysts  or  styes ;  or,  the  edges  of  the  lids  may  become  puffed,  with  heavy 
discharges  during  sleep,  and  a  drying  of  the  matter,  causing  the  lids  to  stick 
together  in  the  mornings.  This  is  readily  removed  with  hot  water  and  a 
soft  cloth.  Sometimes  the  edges  of  the  lids  double  on  themselves,  turning 
outward,  ectropion,  or  inward,  entropion.  Sometimes  they  develop  pea- 
like  tumors,  chalazions.  Sometimes  there  are  to  be  found  under  the  lining 
of  the  lids  granulations,  because  of  the  hardening  of  matter  which  should 
have  been  discharged  by  way  of  the  Meibomian  glands  and  ducts,  but 
which  has  accumulated  on  account  of  the  closure  of  the  ducts.  This 
granulation  is  known  as  "phlyctenular  conjunctivitis,"  "granular  con- 
junctivitis," "trachoma,"  etc.  The  books  referred  to  above  describe  it  as 
"conjunctivitis  catarrhalis  acuta,"  "conjunctivitis  chronica;"  "conjunctivitis 
gonorrhoica,"  "trachomatosa,"  "eczematosa."  And  they  claim  it  is  all  due 
to  bacteria.  Nevertheless,  we  take  all  such  cases,  and  with  our  system  of 
general  treatment,  we  have  fine  results  all  the  time,  even  with  "herpes  zoster," 
which  was  never  known  to  yield  to  local  treatments,  but  which  we  reach  by 
removing  the  causes.  Ptosis,  or  falling  of  the  lids,  is  treated  by  others 
operatively,  and  they  leave  the  eye  with  inability  to  close  the  lids,  while  we 
fix  it  without  operation  and  leave  conditions  normal. 

Conjunctivitis  is,  literally,  inflammation  of  the  conjunctiva,  the  mem- 
brane which  lines  the  lids  and  covers  the  front  of  the  globe.  The  palpebral 
section  has  already  been  referred  to.  The  part  that  covers  the  front  of  the 
globe  is  called  the  ocular  conjunctiva,  which  fits  the  globe  tightly,  and  is  not 
so  liable  to  exhibit  the  granular  deposits  as  the  palpebral  division,  for  two 
reasons.  First,  there  is  not  the  lymphatic  circulation  there  is  in  the  other. 
Second,  the  compactness  of  the  structure  would  prevent ;  but  occasionally 
there  are  such  deposits  even  here.  The  main  features  are  the  connection 
with  the  internal  eye,  through  the  canal  of  Schlemm,  which  surrounds  the 
cornea  at.  its  margin,  and  which  sometimes  becomes  injected  from  pressure 
within  the  eye  until  it  appears  as  a  bright  red  ring.  This  will  be  mentioned 
again  in  referring  to  "Iritis."  The  lachrymal  apparatus  begins  at  the  upper 
outer  corner  of  the  orbit,  in  a  depression  of  which  lies  the  lachrymal  gland 
which  lubricates  the  eye  by  way  of  several  little  ducts  controlled  by  branches 
of  the  third  nerves ;  in  cases  of  hyperopia  and  the  accommodative  effort  to 


192 


overcome  it,  when  the  spasm  stage  is  reached  these  ducts  refuse  to  deliver, 
so  that  the  eyes  become  dry  and  itchy  from  friction;  in  Nature's  attempt 
to  relieve  this  the  blood  vessels  of  the  conjunctiva  become  injected.  Over 
in  the  nasal  angle  of  the  lids  there  is  a  prominence  called  the  "lachrymal 
papilla,"  highly  vascular,  in  which  are  little  punctures  which  lead  to  the 
lachrymal  canal  and  nasal  duct.  Sometimes  an  ordinary  cold  will  be  suffi- 
cient to  set  up  a  disturbance,  and  when  the  vessels  of  this  lachrymal  papilla 
become  congested  it  closes  the  little  punctures  so  that  the  tears  cannot  pass 
out  in  the  ordinary  manner,  hence  overflow  on  the  cheek.  This  overflow  is 
called  "epiphora."  It  may  also  come  from  another  cause,  viz :  when  a  per- 
son's nerve  supply  is  weak  the  mouths  of  the  ducts  from  the  lachrymal 
glands  relax  and  flood  the  eyes  with  tears  in  greater  quantity  than  can  be 
carried  off,  hence  they  overflow.  Returning  to  the  congested  lachrymal 
papilla  in  which  there  sometimes  develops  a  tumor  or  cyst  from  starchy 
deposits  in  the  blood  presenting  a  very  angry  appearance  which  has  fright- 
ened patients  and  doctors  needlessly :  doctors  have  named  it  "Dacryocys- 
titis,"  and  that  of  course  adds  to  the  patient's  fright.  Sometimes  this  con- 
gestion extends  into  the  vessels  of  the  conjunctiva  and  is  directed  toward  the 
oornea,  developing  such  a  vascular  thickenmg  that  it  looks  like  a  little  muscle 
with  a  translucent  point  on  it — something  like  a  finger  nail — a  sort  of  ad- 
vance guard,  which  pushes  on  ahead  of  the  injection,  and  when  it  gets  up 
over  the  cornea  in  front  of  the  pupil,  it  will  of  course  obstruct  vision,  because 
it  is  not  transparent.  This  growth  is  called  a  pterygium,  meaning,  literally, 
a  little  wing;  some  doctors  have  "diagnosed"  it  as  cataract,  which  is  foolish 
because  cataracts  only  form  in  the  crystalline  lens.  The  old  way  of  treat- 
ment for  pterygium  is  to  dissect  it  away,  but  this  does  not  remove  the  cause 
and  it  returns.  Our  method  is,  in  addition  to  the  general  treatment  described 
in  the  beginning  of  this  chapter,  the  vigorous  application  of  strong  salt 
water  with  an  atomizer;  the  astringent  quality  of  the  salt  combined  with 
the  cold  empties  the  vessels  and  prevents  their  being  refilled,  because  we 
have  the  errors  corrected  and  other  causes  removed,  so  that  in  due  course  of 
time  Nature  restores  normal  conditions.  Some  express  doubts  about  this 
because  the  habit  has  been  to  assume  that  when  things  go  wrong  Nature 
gives  up,  but  anyone  who  has  seen  Nature  handling  a  boil,  getting  rid  of  the 
"core,"  then  healing  the  opening,  nearly  always  without  leaving  a  scar, 
will  be  reminded  that  Nature  knows  how  to  do  the  work.  Everyone  should 
be  cautioned  against  allowing  any  such  conditions  to  develop  to  the  hyper- 
trophic  state,  because  the  more  malignant  they  are  the  longer  it  takes  to 
handle  them,  and  a  "chronic"  case,  that  is,  one  which  has  been  neglected  or 
mistreated,  is  liable  to  develop  a  net-work  of  vessels  all  over  the  cornea,  and, 
as  it  is  a  sore,  it  will  naturally  develop  ulcers,  the  ulcers  produce  scars,  and 
years  will  be  required  to  reabsorb  such  tissue ;  indeed  it  may  never  be  ac- 
complished. This  net  work  is  known  as  "pannus,"  and  the  treatment  for  it 
by  the  old  schools  has  been  the  use  of  caustics,  such  as  sulphate  of  copper, 
which  treatment  is  sufficient  to  produce  ulcers,  and  to  intensify  them  if 
they  are  present.  All  such  cases  if  treated  in  time  by  our  methods,  the 
patient  remaining  indoors,  are  relieved  without  possibility  of  injury,  and 
usually  without  leaving  scars.  This  is  always  the  case  if  we  get  them  early 


ALLEGED  EYE  DISEASES  19! 


enough.  Patients  are  always  frightened,  sometimes  until  they  are  "sick  at 
their  stomachs,"  and  they  are  usually  hard  to  handle,  because  they  have  an 
insane  desire  for  drug  treatment.  If  they  insist  on  it,  send  them  to  the  other 
fellow,  and  tell  them  to  never  return,  no  matter  what  happens.  The  books 
tell  us  that  most  of  these  troubles  are  gonorrhoeal.  One  Dr.  Fuchs  gives 
the  following  childish  explanation :  "The  poison  can  be  introduced  into  the 
eye  from  the  genitals  directly,  generally,  because  an  individual  (whether 
man  or  woman)  affected  with  gonorrhoea  touches  the  eyes  with  unclean 
fingers  after  these  have  been  in  contact  with  the  genitals."  How  marvelous 
— it  may  be  done  either  by  a  man  or  a  woman ! 

Ophthalmia  neonatorum  is  the  conjunctivitis  exhibited  in  the  new  born 
from  a  local  infection,  by  uncleanly  delivery,  or  it  may  be  from  atmospheric 
influences,  and  for  this  reason  the  old  schools  recommend  that  a  strong 
solution  of  nitrate  of  silver  be  used  in  the  eyes  immediately.  This  is  criminal, 
although  not  legally  so  regarded.  A  good  hot  bath,  followed  by  the  in- 
stillation of  cold  salt  water  can  do  no  possible  harm,  and  no  infection,  bug 
or  otherwise,  can  survive  in  salt  water.  The  so-called  diphtheric  and 
eczematous  conjunctivitis  are  due  to  errors  of  refraction,  associated  with 
systemic  disorders,  and  they  are  not  amenable  to  treatment  with  drugs,  but 
yield  readily  to  our  general  system,  including  special  diets.  There  are  oc- 
casions when  the  ocular  conjunctiva  is  injured  by  accidents,  but  a*s  has 
been  remarked  before,  any  ordinary  laceration  will  heal  itself  in  a  few  hours 
if  let  alone. 

The  Cornea  and  Sclerotic  constitute  the  outer  coat  of  the  eye  and  are 
as  tough  as  leather;  the  cornea  gets  its  name  from  the  word  "horn,"  and 
the  word  "sclerotic"  means  hard.  Neither  of  these  parts  of  the  eye  has  any 
nerve  or  blood  vessel  worth  mentioning,  except  that  around  the  edge  of  the 
cornea,  including  the  canal  of  Schlemm,  there  is  a  fairly  good  supply  of  each, 
and  the  sclera  is  pierced  by  vessels  about  the  equator  and  posteriorly.  The 
cornea  is  constructed  of  several  layers,  some  of  them  cellular  and  some 
fibrous,  and,  being  live  tissue  in  contact  with  the  ocular  conjunctiva,  there 
is  a  possibility  of  corneal  structure  being  involved  in  cases  of  ulceration,  but 
we  have  our  doubts  whether  this  would  ever  occur  if  escharotics  were  not 
used.  The  books  devote  much  space  to  keratitis,  inflammation  of  the  cornea, 
and  sclerotitis,  but  without  any  reasonable  ground  for  it.  They  also  say 
that  there  is  "photophobia"  (painful  vision)  in  conjunctivitis,  when  any- 
one ought  to  know  that  painful  vision  should  not  occur  from  such  a  cause, 
but  only  from  inflammation  of  the  retina.  Of  course,  conjunctivitis  might 
be  present  at  the  same  time,  but  it  has  nothing  to  do  with  the  painful  vision. 
There  are  some  things  that  happen  to  the  cornea,  such  as  assuming  a  con- 
ical form  called  keratoconus ;  then  there  is  a  sort  of  degeneration  of  the  tissue 
which  sometimes  occurs,  called  "keratomalacia,"  in  which  it  assumes  a 
semi-transparency,  and  these  are  both  conditions  for  which  no  one  has  yet 
been  able  to  do  anything  good. 

The  Iris,  Ciliary  Body  and  Choroid  constitute  what  is  called  the  uveal 
tract,  because  when  this  layer  is  exhibited  alone  it  is  about  the  color  and 
shape  of  a  grape.  This  is  a  highly  vascular  and  nervous  layer,  excepting  the 
iris,  and  in  the  ciliary  body  lies  the  mechanism  of  accommodation  which 


15)4  A  SYSTEM  OF  MATURE  MEDICINE 

operates  the  crystalline  lens.  In  the  chapter  on  Anatomy  of  the  Eye  will  be 
found  the  anatomical  details.  Physiologically  the  effort  of  accommodation 
to  overcome  hyperopia  being  such  an  unusual  demand  upon  the  nervous 
system,  and  meeting  with  the  resistance  it  does  in  the  suspensory  ligaments, 
there  is  a  heating,  the  same  as  in  an  electric  battery,  under  similar  condi- 
tions, and  in  order  to  keep  the  eye  cool  an  excessive  amount  of  blood  is  sup- 
plied automatically.  This  not  only  causes  increased  tension  of  the  eye  ball, 
but  the  cramp  which  often  occurs  in  the  sphincter  nerves  causes  pain.  The 
old  schools  have  denominated  this  "rheumatism"  of  the  eye.  It  is  really 
neuralgia  (nerve  pain).  These  are  several  possible  results,  one  is  that  the 
congestion  and  overheating  develops  a  hypertrophic  condition,  which,  if  not 
relieved,  may  reach  a  stage  where  it  breaks  down,  that  is,  atrophy  begins, 
and  in  such  cases  the  whole  interior  of  the  eye  collapses,  destroying  it.  Hap- 
pily, being  well  protected  from  outside  influences  this  does  not  often  occur. 
The  preliminary  stages  indicated  by  the  pain  from  tonic  spasm,  and  in- 
flammation of  the  retina,  developed  sympathetically,  together  with  painful 
vision  cause  the  sufferer  to  seek  aid,  and  when  the  errors  of  refraction  are 
corrected  the  cause  is  removed,  when,  if  a  reasonable  time  is  given  for  the 
inflammation  to  subside,  normal  conditions  will  be  resumed  and  there  will  be 
no  further,  trouble.  The  first  stages  are  all  included  in  the  word  "cyclitis," 
but  when  the  extraordinary  stage  is  reached,  it  is  known  as  ''glaucoma.5' 
The  old  schools  ''diagnose"  glaucoma  when  it  is  simple  cyclitis,  just  as  a 
young  doctor  diagnoses  every  case  of  bilious  fever  as  typhoid.  Almost  any 
old  doctor  will  say  he  had  more  cases  of  typhoid  fever  the  first  year  of  his 
practice  than  he  has  ever  seen  since.  So  it  is  with  young  oculists.  They 
find  an  abundance  of  glaucoma  where  we  older  ones  only  find  cyclitis. 
There  is  this  difference,  however,  that  all  of  the  old-school  oculists — young 
and  old — 'find  the  glaucoma.  It  is  only  Neurological  doctors  who  differen- 
tiate, and  we  declare  that  a  genuine  case  of  glaucoma  cannot  be  cured  any 
more  than  life  can  be  restored  to  a  dead  person.  The  same  people  are  always 
finding  iritis,  and  they  have  eight  kinds  of  it.  Viz:  syphilitica,  scrofulosa, 
gonorrhoica,  rheumatica,  tuberculosa,  acute  infectious,  disorders  of  metab- 
olism, traumatica.  As  a  matter  of  fact,  there  is  very  little  iritis,  because 
the  iris  is  scantily  supplied  with  blood  and  nerves,  and  because  it  hangs  in 
a  solution  of  salt  water,  the  aqueous  humor.  In  a  preceding  paragraph 
the  canal  of  Schlemm  was  referred  to,  and  instances  of  its  injection  with 
blood,  an  overflow  from'  the  ciliary  body.  This  exhibit  is  the  old-school 
reason  for  diagnosing  iritis.  It  always  means  cyclitis,  and  instead  of  being 
treated  with  atropin  and  other  drugs,  the  proper  and  only  treatment  is  that 
described  above  as  our  general  treatment.  It  is  true  that  the  administration 
of  atropin  would  have  a  tendency  to  paralyze  the  nerves  of  accommodation, 
and,  incidentally,  give  temporary  relief,  but  that  is  not  removing  the  causes 
of  trouble ;  and,  as  soon  as  the  effect  of  the  drugs  disappears,  the  trouble 
begins  again.  This  is  why  the  old-school  doctors  have  "recurrent"  cases. 
We  never  do.  Their  treatment  includes  bleeding  with  leeches,  confining 


ALLEGED  EYE  DISEASES  195 


in  a  dark  room,  colored  glasses,  etc.,  all  of  which  are  harmful  because  they 
are  not  rational;  can  do  no  good,  hence  do  harm. 

The  Crystalline  Lens  is  the  adjustable  part  of  the  dioptric  system,  and 
to  be  useful,  must  remain  transparent.  It  is  subject  to  the  development  of 
an  opacity  called  cataract,  a  name  that  doesn't  fit  it,  which  is  of  four 
varieties :  congenital,  present  at  birth,  when  the  lens  is  as  white  as  ivory ; 
traumatic,  caused  by  injury,  may  develop  in  a  night  from  a  blow  on  the 
eye ;  systemic,  one  which  develops  from  derangements  of  body  chemistry, 
and  may  occur  at  any  age ;  senile,  that  which  is  incident  to  old  age.  The 
latter  is  always  found  to  have  a  history  of  hyperopia,  and  it  is  possible  that  it 
is  due  to  the  heating  of  the  entire  internal  eye.  Sometimes  this  opacity 
comes  on  gradually,  and  in  the  form  of  a  spider's  web ;  sometimes  it  begins 
in  the  middle  of  the  lens  and  gradually  spreads  outward  until  it  involves  the 
whole  lens.  Sometimes  it  is  soft  and  sometimes  it  becomes  hard.  Some- 
times it  begins  at  the  anterior  pole  of  the  lens;  sometimes  posteriorly;  and 
sometimes  around  the  edge.  As  a  rule  they  develop  slowly,  and  may  be  in 
one  or  both  eyes.  Again,  in  very  old  people  who  grow  suddenly  fat,  they 
first  develop  emmetropia  where  they  have  been  hyperopic,  so  that  they 
leave  off  their  distant  glasses;  later  they  leave  off  their  reading  glasses, 
and  examination  shows  they  have  become  myopic,  yet  the  lens  remains 
transparent  or  very  slightly  cloudy;  occasionally  it  becomes  opaque.  In 
such  cases  it  tells  us  that  dissolution  is  taking  place,  and  that  the  patient 
has  not  long  to  live.  In  cases  of  slow  development  they  may  live  many 
years.  The  old  treatment  was  operation,  and  in  many  cases  that  is  the  only 
thing,  but  some  cases  have  been  treated  successfully  by  the  instillation  of 
a  drop  or  two  three  times  a  day  of  succus  cineraria  maritima,  or  oil  of  thuyit 
occidentalis,  or  a  : saturated  solution  of  common  salt,  or  undiluted  lemon 
juice,  all  of  which  cause  an  intense  burning  sensation  for  a  few  minutes, 
during  which  the  eyes  should  be  kept  closed  to  keep  the  tears  from  washing 
the  application  out.  We  have  seen  some  very  excellent  results,  and  we 
have  seen  cases  where  it  failed  utterly,  which  proves  again  the  uncertainty  of 
anything  applied  as  drug  "remedies"  are  employed.  Operation  is  the  only 
sure  thing  to  get  rid  of  the  cataract,  but  this  does  not  mean  it  is  sure  to 
give  vision,  because  the  retina  may  be  involved.  It  is  advisable  to  let  them 
alone  as  long  as  one  eye  remains  good.  There  is  no  possible  harm  can  come 
from  this,  and  there  is  absolutely  no  pain  during  the  development  of  the 
cataract,  or  after  it  is  developed,  because  there  are  no  nerves  in  the  crys- 
talline lens.  The  operation  for  cataract  is  painless,  so  that  those  who  find 
it  necessary  need  have  no  fears  on  that  score.  After  operation,  of  course, 
glasses  will  have  to  be  worn  in  order  to  have  any  distant  vision,  and  a 
second,  stronger  pair,  will  have  to  be  used  for  near  work,  because  the  power 
of  accommodation  is  gone.  In  cases  where  one  eye  is  injured,  and  cataract 
develops,  the  best  thing  to  do  is  to  let  it  alone  and  give  attention  to  the 
other.  One  case  in  my  experience  was  that  of  a  stenographer  at  the  Stock 
Yards  who  attended  a  wake,  and  a  frivolous  young  man  sailed  a  hat  across 
the  room,  which  struck  her  in  the  eye,  so  injuring  it  that  a  cataract  developed 
the  next  day,  and  there  was,  incidentally,  a  considerable  external  inflamma- 
tion from  the  injury.  After  a  few  days  her  family  physician  brought  her  to 


196  A  SYSTEM  OF  MATURE  MEDICINE 

me,  bewailing  the  loss  of  her  two  eyes,  as  she  could  not  see  to  get  around 
without  help.  After  questioning  I  decided  to  investigate  the  uninjured  eye, 
when  I  found  she  was  myopic  about  six  units ;  I  gave  her  a  correction  with 
almost  normal  vision,  showed  her  she  had  never  been  using  that  eye  be- 
fore, which  eased  her  mind,  and  she  has  been  content  to  forget  the  cat- 
aractous  eye.  An  operation  would  have  been  a  very  doubtful  one  in  that 
case,  and  if  the  eye  had  been  usable  afterwards,  it  would  have  required  a 
very  strong  -f-  lens,  while  the  other  one,  using  a  strong  — ,  would  have 
given  her  a  very  queer  appearance  indeed. 

The  Vitreous  Humor  is  liable  to  opacities,  which  exhibit  in  the  form  of 
floating  specks  called  "muscae  volitantes."  We  have  found  these  attended 
by  history  of  very  wrong  living  in  the  younger  people,  that  is,  they  indulge 
in  too  much  sweet  and  starchy  food ;  but  by  correcting  the  errors  and  chang- 
ing the  diet  we  get  good  results  very  quickly.  When  they  appear  in  older 
people  it  is  an  incident  to  the  chemical  changes  of  the  body,  due  to  age,  and 
while  we  have  secured  improvement,  we  have  rarely  been  able  to  eliminate 
them  entirely. 

The  Retina  has  been  the  subject  of  more  slander  than  any  other  part  of 
the  body.  In  the  first  place,  the  macula  lutea  (spot  yellow)  of  Soemmering 
is  a  fraud,  there  isn't  any  such  place,  except  that -there  is  a  field  around  the 
posterior  pole  of  the  eye  which  may  be  regarded  in  a  general  way  as  a  spot, 
but  it  is  not  marked  by  any  lines,  colors,  or  anything  else  whatever ;  in  the 
text  books  it  is  pictured  as  a  brown  spot ;  it  is  neither  brown  nor  yellow,  but 
is  simply  a  pinkish  color  like  all  the  rest  of  the  retina.  One  noticeable  thing 
about  that  field  is  there  are  no  large  vessels,  rarely  any  large  enough  to  be 

distinguished.  Fig.  110  shows  a  normal 
retina,  the  optic  disc  showing  a  well  defined 
edge,  the  vessels  meeting  in  the  center  and 
disappearing.  The  lighter  ones  are  arteries, 
and  the  darker  ones,  veins.  This  was  drawn 
from  the  right  eye  of  a  normal  person, 
hence  the  macular  field  is  on  the  left  side  of 
the  disc  as  we  look  at  it,  and  may  be  said 
to  include  a  space,  beginning  at  the  edge  of 
this  disc,  H  times  the  diameter  of  the  disc ; 
in  the  center  of  it  is  the  posterior  pole  of 
Fig.  no  the  eye.  The  fovea  centralis  is  at  the  pos- 
terior pole,  and  not  at  a  point  5  degrees  outside  of  it,  as  some  have 
asserted.  Many  people  have  been  deceived  by  the  books,  which  have  led  them 
to  believe  that  the  pictures  of  retinae  are  photographs.  I  doubt  very  much  if 
there  ever  was  a  photograph  taken  of  the  eye,  with  one  exception,  viz.,  my 
own,  and  we  didn't  get  a  good  one  then.  I  made  and  patented  a  machine  for 
the  purpose  and  for  use  as  an  indirect  ophthalmoscope,  but  have  never  recom- 
mended it,  because  the  direct  method  is  much  better;  indeed,  nothing  can  take 
its  place.  The  reason  I  undertook  the  photograph  proposition  was  a  wild-eyed 
story  that  was  printed  in  the  Literary  Digest  fourteen  years  ago,  purporting 
to  come  from  Germany ;  it  pictured  an  apparatus,  and  it  struck  me  as  funny 
that  any  person  pretending  any  scientific  knowledge  would  perpetrate  such  a 


ALLEGED  EYE  DISEASES 


thing,  because  it  had  a  half  dozen  batteries  of  lenses  in  it,  and  according  to 
the  drawings  a  picture  would  have  been  an  impossibility.  It  was  proposed  by 
a  German  authority  as  a  valuable  thing  to  study  the  progress  of  "diseased" 

eyes.  My  machine  consisted  of  a  tube, 
shown  in  Fig.  Ill,  with  a  direct  illumi- 
nation and  an  adjustable  sliding  arrange- 
ment, with  a  -f-  8.00  diopter  bi-convex 
lens  in  it.  With  the  aid  of  an  assistant,  I 
succeeded  in  having  a  picture  made  of  my 
own  retina,  with  considerable  pain  to  my- 
self, enough  to  satisfy  me  that  it  would 
not  be  very  pleasant  to  a  person  with  a 
diseased  retina.  One  difficulty  is  in  get- 
ting the  eye  to  hold  still  long  enough  to 
get  a  perfect  picture.  We  tried  a  dozen 
Fig.  111  times  before  we  got  one. 
The  Ophthalmoscope  is  for  the  purpose  of  studying  conditions  of  the 
internal  eye ;  but  not  nearly  so  much  for  local  "diseases"  as  it  is  for  daily  use 
on  every  patient,  to  note  the  quality  and  quantity  of  the  blood  which  is  circu- 
lating in  the  body,  the  size  and  number  of  vessels,  which  range  in  number 
from  six  or  eight  to  thirteen  good-sized  ones.  In  some  cases  we  find  the 
number  comparatively  few,  but  of  good  size  and  the  contents  good.  Normally 
the  arteries  have  a  distinct  white  streak  down  the  center,  occupying  about 
one-fifth  of  the  diameter,  hence  we  say  the  blood  is  80  per  cent  red.  The  blood 
is  so  nearly  transparent  that,  if  the  vessels  were  square,  we  could  scarcely  see 
it,  but  as  the  vessels  are  round  we  only  get  the  axial  reflection  because  we  are 
perpendicular  to  it  alone.  If  the  light  streak  occupies  one-third  of  the  space, 
it  means  only  66  2/3  per  cent  red  blood,  which  is  a  low  quality,  and,  of  course, 
quantity.  Practice  enables  one  to  become  so  expert  in  estimating  the  quality 
by  this  method  that  the  slow  process  of  counting  corpuscles  is  done  away 
with,  and  when  others  have  made  the  count  after  us,  they  have  corroborated 
us  every  time.  There  are  generally  two  or  more  veins  for  each  artery,  and 
they  are  somewhat  darker,  because  they  carry  waste  from  the  body ;  but  in 
young  and  healthy  children  they  have  a  distinct  light  streak,  and  the-  only 
way  we  can  tell  the  difference  between  them  and  arteries  is  that  they  are 
larger.  There  is  a  difference,  too,  in  the  showings  of  healthy  people  of  differ- 
ent complexions,  because  in  some  there  is  more  coloring  matter  than  in  others, 
but  the  operator  soon  learns  how  to  regard  these  slight  differences.  Some- 
times we  get  surprises :  patients  will  come  with  a  fairly  good  external  appear- 
ance, but  when  we  examine  them  with  the  ophthalmoscope  we  find  at  once 
they  are  deficient  in  blood  supply,  not  only  in  the  quality  and  quantity  of 
blood  in  the  vessels,  but  in  the  number  of  branches  exhibiting  in  the  eye, 
which  is  a  fair  sample  of  the  general  distribution,  and  when  we  finally  meas- 
ure the  nerve  supplies  of  such  cases,  we  invariably  find  them  below  their  dan- 
ger line.  It  fell  to  my  lot  to  make  such  a  discovery  in  my  own  brother,  and 
according  to  the  analysis  of  his  case,  he  had  less  than  six  months  to  live,  unless 
by  strict  obedience  to  instructions  indicated,  he  might  have  regained  his  nor- 
mal status.  Like  a  great  many  others,  he  could  not  believe  it  possible  that 


198  A  SYSTEM  OF  MATURE  MEDICINE 

anyone  could  analyze  a  case  with  such  a  degree  of  certainty;  he  had  important 
business  affairs  to  attend  to,  and  he  took  the  chance.  He  lived  four  months. 
In  many  other  cases  conditions  shown  by  the  analysis  were  startling,  and 
like  the  one  mentioned,  the  victims  could  not  be  impressed  with  the  impor- 
tance of  heeding  the  warning.  They  all  died  within  the  time  predicted. 

There  are  two  symptomatic  points  which  must  be  regarded  in  every  case, 
one  being  the  quality  of  the  blood,  both  arterial  and  venous,  and  the  other  the 
quantity,  based  upon  the  apparent  supply  in  the  vessels  and  the  number  of 
vessels  compared  with  the  average  number  found.  Qualitatively,  if  the  light 
streak  in  the  arteries  occupies  one-fifth,  we  record  it  -)-.  If  it  is  more  than 
that,  we  record  it  — ;  if  the  veins  are  so  light  colored  that  there  is  a  pale  streak 
down  the  center,  we  mark  it  -(-,  but  if  the  vessels  are  very  dark  we  mark  it  — , 
except  in  cases  of  very  old  people,  when  we  expect  to  find  both  the  arteries 
and  veins  somewhat  below  normal,  viz.,  the  light  streak  in  the  arteries  wider 
and  the  venous  blood  darker.  Quantitatively,  we  record  the  number  of  ves- 
sels found,  specifying  the  number  of  arteries  and  veins  separately,  and  make 
reference  to  the  calibre. 

Occasionally  we  have  exhibits  of  retinitis.  It  begins  at  the  edge  of  the 
optic  disc  (sometimes  called  papilla,  sometimes  the  blind  spot),  and  extends 
radiantly  outward,  the  congestion  sometimes  being  intense  enough  to  obscure 

the  edge  of  the  disc,  as  shown  in  Fig.  112.  This 
was  a  case  of  so-called  "Optic  Neuritis,"  or  "Neuro- 
retinitis,"  produced  by  reflex  in  dysmenorrhea.  It 
is  purely  mechanical  and  is  commonly  called 
"choked  disc."  Note  how  dark  and  congested  the 
veins  are,  and  how  light  and  empty  the  arteries. 
The  primary  cause  was  the  accommodative  effort 
to  overcome  hyperopia,  which  set  up  such  an  intense 
'Fig.  112  general  nervous  spasm  it  involved  the  sphincter 
nerves  of  the  os  uteri,  and  when  the  additional  pressure  at  the  catamenial  per- 
iod was  added,  it  reacted  and  put  the  nervous  system  into  a  worse  spasm,  this 
time  involving  the  sheath  of  the  optic  nerve,  whicli  also  encloses  the  retinal 
vessels,  and  pinched  so  tightly  arterial  blood  couldn't  get  in  and  venous  blood 
couldn't  get  out  of  the  eye ;  there  was  also  tonic  spasm  of  accommodation,  ac- 
companied by  great  pain.  A  patient  had  been  told  that  an  operation  on  the 
eye  would  be  necessary  (just  what  the  nature  of  that  operation  was  the  pa- 
tient was  unable  to  report)  ;  but  having  noted  the  special  exhibit  in  the  eyes 
at  her  menstrual  periods  for  a  considerable  time  she  mentioned  that  fact,  and 
while  the  oculist  told  her  it  had,  no  doubt,  something  to  do  with  the  eyes,  he 
did  not  tell  her  that  the  menstrual  trouble  was  due  to  the  eye  error  in  the 
first  place.  He  did  not  know  it.  We  found  a  high  degree  of  hyperopia,  and 
in  two  months  had  her  all  right  in  every  particular,  vision  normal,  and  no 
pains  whatever  at  her  monthly  periods. 

There  are  other  cises  presenting  a  similar  appearance,  except  that  the 
large  vessels  are  neither  empty  or  congested,  but  the  inflammation  is  more 
wide  spread ;  they  come  from  chemical  changes  in  the  body,  and  it  is  very 
important  that  they  be  looked  after  in  a  broader  way  than  the  Ophthalmolo- 


ALLEGED  EYE  DISEASES 


15)9 


gist  can  do,  therefore,  if  no  Neurologist  is  near,  the 
patient  should  make  the  journey  to  see  one,  because 
while  it  does  not  always  mean  that  form  of  toxemia 
commonly  known  as  "Bright's  disease,"  or  "Album- 
inuria,"  it  is  very  likely  to  be  something  of  that  na- 
ture. If,  in  addition  to  the  inflammation  around  the 
disc  there  be  yellowish  patches,  from  the  size  of  a 
pin  head  to  much  larger,  as  shown  in  Fig  113, 
it  means  kidney  trouble  in  the  second  stage 
of  progress.  If,  in  addition  to  the  inflammation  and  yellow  patches,  some  of 
the  patches  are  white,  it  indicates  the  third  stage,  and  if  there  is  the  addition 
of  black  patches,  as  shown  in  Fig.  114,  it  indicates  the  last  stage  of  so-called 
"Bright's  disease."  The  Ophthalmologist  should 
have  nothing  to  do  with  either  of  the  last  two  stages. 
It  will  do  no  harm  to  correct  their  eye  defects,  but 
that  would  not  be  sufficient  to  do  much  good  in  a 
general  way. 

In  what  is  commonly  known  as  the  "diabetic 
diathesis"  the  patient  will  complain  of  seeing  float- 
ing specks  before  the  eyes  ;  we  may  see  nothing 

with  the  ophthalmoscope,  although  there  is  a  prob-  ^"^J^BP*^  Kiu;  114 

ability  we  will  find  a  dappled  appearance  of  the  retina.  However,  the  float- 
ing specks  are  sufficient  to  tell  us  what  the  trouble  is  ;  the  patient  is  eating 
too  much  sweets,  fats,  starches,  and  possibly  using  liquor.  A  patient  may 
have  quite  an  acute  retinitis  so  that  vision  is  painful  and  there  be  no 
ophthalmoscopic  appearance  indicating  it,  but  we  know  it  is  there  and  that 
only  the  nerves  are  involved.  This  is  usually  found  in  connection  with  ex- 
cessive accommodation  to  overcome  hyperopia. 

In  some  cases  of  congenital  syphilitic  infection  we  find  children  going 
blind,  and  upon  ophthalmoscopic  examination  we  see  streaks  of  retinal  pig- 
mentation, or  in  other  words,  streaks  of  pigment  are  seen  where  the  retina  has 
become  atrophied.  This  trouble  begins  anteriorly  and  works  backward,  and 
by  the  time  we  find  it,  it  is  too  late  to  do  any  good.  The  books  call  this 
"retinitis  syphilitica,"  but  "retinitis"  means  inflammation,  and  we  do  not  find 
inflammation  in  such  cases  unless  the  kidneys  are  involved,  too,  which  is  very 
rarely. 

Fig.  115  shows  a  plugging  of  a  vessel,  known 
as  a  "thrombolism"  or  "embolism."  If  the  plug 
is  at  the  end  of  the  dilation,  toward  the  disc,  it  is 
in  a  vein,  and  manipulation  may  help  get  rid  of 
it.  If  it  is  at  the  other  end,  it  is  in  an  artery  and 
manipulation  would  cause  trouble  :  hence,  the 
best  way  to  treat  such  a  case  is  to  stop  all  work 
with  the  eyes,  have  the  patient  indulge  in  many 
hot  baths  and  get  thoroughly  relaxed,  when  the 
P^g  wiU  work  its  own  way  out.  Sometimes 
when  the  vascular  walls  are  weak  the  vessel  will  burst  and  give 
an  appearance  like  Fig.  116.  The  patient  may  be  temporarily  blinded, 


115 


200  A  SYSTEM  OF  MATURE  MEDICINE 

but  in  time  absorption  will  occur,  if  the  patient 
is  careful. 

There  are  comparatively  few  retinal  exhibits  ol 
eye  pathology,  and   hundreds  of  so-called  "dis- 
ease" pictures  are  pure  humbugs.    We  have  seen 
some  cases  of  anatomical  freaks  in  which,  while 
there    were    remarkable    appearances    of    black, 
white,   greenish   and   variegated   deposits,    there 
were  no  signs  of  there  having  been  inflammation 
'pig   lie    or  other  trouble,  and  the  patients  either  had  good 
vision  or  possibly  none  at  all,  but  had  always  been  that  way. 

Referring  again  to  "glaucoma" :  It  has  been  asserted  by  the  old-school 
doctors  that  there  are  certain  symptoms  which  always  indicate  that  "disease," 
namely :  patients  complain  of  seeing  halos  around  lights,  tension  of  the  eye- 
balls is  hard  (some  say  soft),  there  are  increasing  exhibits  of  manifest  hyper- 
opia,  and  the  ophthalmoscope  shows  a  deep  cupping  of  the  disk,  with  some  or 
all  of  the  vessels  turning  in  at  the  edge  of  the  disk.  Many  years  ago  one  of 
my  pupils  brought  a  case  to  the  college,  who  exhibited  all  of  the  symptoms 
enumerated.  He  was  a  student  at  the  Physio-Medical  school  on  the  West 
Side,  Chicago,  where  the  professor  of  ophthalmology  had  pronounced  it  a  gen- 
uine case.  Fig.  117  is  a  drawing  I  made  at  the  time,  and  it  is  accurate.  The 
young  man  who  brought  the  case  was  also  a  student  at  the  P-M,  and  had 
found  first,  .50  hyperopia,  then  1.00  and  finally  1.50.  On  account  of  the  symp- 
toms, he  referred  the  case  to  the  professor;  but  after  hearing  his  diagnosis  and 
suggestions  of  enucleation,  he  brought  the  case 
to  me.  He  had  normal  vision  with  naked  eyes, 
and,  having  worn  +  1-30  for  several  weeks,  was 
in  good  condition  to  accept  full  correction,  which 
I  found  to  be  +  2.50.  It  was  a  case  of  tonic 
spasm  with  some  cyclitis  and  pain  at  first,  both 
of  which  disappeared  quickly  with  complete  re- 
moval of  the  cause.  I  found,  by  questions  that 
he  had  always  practiced  the  habit  of  staring  at 

lights,  which   accounted   for  the   halos  he  saw ;  ^^^^^^^^ 

his  tonic  spasm  accounted  for  the  pain  and  for 

the  extra  tension  of  the  eyeballs ;  his  cyclitis  naturally  involved  some 
retinitis  and  the  variable  vision  h,e  had  exhibited  before  wearing  glasses.  The 
only  conclusion  with  reference  to  the  cupped  disk  was  that  it  was  an  anatomi- 
cal freak.  I  met  the  man  often  during  the  next  four  years  and  he  was  all 
right.  Since  then  I  have  occasionally  met  similar  cases  and  have  known 
many  who  had  been  told  they  had  "glaucoma"  who  recovered  very  quickly 
under  rational  methods. 

In  January,  1916,  one  of  the  students  in  our  Department  of  Ophthal- 
mology met  a  man  in  a  barber-shop  who  was  wearing  smoked  glasses  and 
whose  eyes  were  inflamed  and  granulated  externally  and  who  complained 
of  the  light  hurting  his  eyes.  Upon  questioning  him  it  was  learned  that 
he  had  "trachoma"  and  was  then  suffering  one  of  his  periodical  "back-sets," 
according  to  his  oculist.  Only  that  day,  in  the  class-room,  I  had  asserted 


ALLEGED  EYE  DISEASES  201 


that  the  "trachoma"  fad  was  worse  than  the  "glaucoma"  one,  because  there 
are  more  cases  of  it.  The  student  took  advantage  of  the  opportunity  to 
"try  me  out"  as  he  expressed  it.  He  boldly  asserted  the  case  wouldn't  last 
a  month  under  our  methods.  The  man  came  around  that  evening  and  made 
an  appointment  for  the  next  day.  Examination  revealed  a  "typical  case" 
with  the  addition  of  a  well  marked  ptosis.  He  had  a  pair  of  -f-  .50  "toric" 
lenses,  to  be  used  for-  reading  only,  and  wore  smoked  glasses  for  general 
use.  He  said  he  had  been  treated  for  over  thirty  years.  Naturally  he  was 
not  in  condition  to  be  fitted  with  glasses;^ he  was  highly  nervous,  and  vision 
was  only  1%0-  I  put  on  +  3.00  temporary  lenses,  stopped  work  for  a  few 
days  while  he  took  hot  all-over  baths,  hot  towels  to  the  eyes,  followed  by 
cold  salt-water  applications,  plenty  of  sleep  and  wholesome  food.  In  four 
days  he  reported  the  painful  sensations  from  light  had  disappeared  and  the 
external  inflammation  was  much  reduced.  Three  weeks  later  he  was  dis- 
missed, sound  as  a  dollar,  wearing  +  3.50  bi-convex  spheres  and  reading 
the  normal  line  on  the  test  card. 

Exophthalmic  goitre  is  a  protrusion  of  the  eyeballs  associated  with  en- 
largement of  the  thyroid  glands.  It  is  a  symptom  of  disorder,  the  causes  of 
which  are  generally  so  obscure  they  have  never  been  located.  I  have  found 
that  one  of  them  is  hyperopia,  because  many  cases  have  yielded  readily  to 
correction  of  that  eye  defect  and  with  the  additional  help  of  baths,  diet  and 
general  hygienic  measures  the  neck  exhibit  disappeared.  My  first  case  was 
about  eighteen  years  ago,  when  a  woman  came  to  take  a  course  in  Ophthal- 
mology. She  was  about  twenty-six  years  old,  weighed  about  180  pounds 
and  was  wearing  —  2.50  lenses,  prescribed  by  a  western  oculist.  She  was  a 
mother  and  had  undergone  a  hysterectomy,  after  which  the  goitre  developed. 
Her  glands  were  both  greatly  enlarged  and  the  eyes  protruded  decidedly. 
Examination  proved  her  to  be  a  hyperope  of  2.50  instead  of  a  myope  of  that 
amount,  so  that  with  her  —  lenses  on  she  was  a  hyperope  of  5.00.  In  three 
months  the  exhibit  disappeared  and  we  reduced  her  weight  to  140  pounds. 
I  have  seen  her  nearly  every  year  since  and  there  has  been  no  signs  of  re- 
turn. Other  cases  gave  equally  good  results,  while  some  still  retain  par- 
tial enlargement  of  the  glands,  although  they  have  suffered  no  inconven- 
ience therefrom. 

Progressive  Myopia  is  one  of  the  conditions  which  demand  considera- 
tion in  this  chapter.  It  usually  develops  between  the  ages  of  six  years  and 
maturity;  it  is  marked  by  high  tension  of  the  eyeballs,  demand  for  increased 
power  of  the  —  lenses  at  frequent  intervals  and  the  ophthalmoscope  reveals 
a  white  crescent  on  the  polar  edge  of  the  optic  disk  while  the  large  vessels 
turn  abruptly  toward  the  nose  before  disappearing.  It  is  due  to  systemic 
changes  which  increase  the  volume  of  the  vitreous  humor,  putting  such  pres- 
sure on  the  posterior  pole  of  the  globe  that  there  is  a  bulging  (posterior 
staphyloma)  ;  this  pressure  and  consequent  bulging  first  stretches  th%  layers 
of  the  globe  until  it  is  too  long  on  the  axis  for  the  original  lenses  and  strong- 
er ones  are  required.  If  this  condition  is  not  arrested  the  final  result  will  be 
that  the  retina,  which  has  already  been  torn  loose  from  the  edge  of  the  disk 
when  the  crescent  is  seen,  will  be  destroyed  entirely  so  far  as  the  macular 
field  is  concerned.  When  that  stage  is  reached  the  ophthalmoscopic  view 


202  A  SYSTEM  OF  MATURE  MEDICINE 

discloses  the  white  sclerotic  and  fragments  of  the  pigment  layer,  with  some- 
times clots  of  blood  from  the  torn  choroid  if  the  rupture  is  a  recent  one.  Of 
course  nothing  can  be  done  for  such  cases  in  the  latter  condition.  If  taken 
early  the  correction  of  the  error  of  refraction,  out-door  life  and  proper  food 
will  stop  progress  permanently.  All  cases  of  myopia  in  children  should  be 
corrected  carefully,  using  the  weakest  --  lenses  that  will  give  20/30  vision 
and  the  above  programme  suggested.  It  is  an  aged  axiom  that  "an  ounce  of 
prevention  is  worth  a  pound  of  cure." 

Epilepsy  is  one  of  the  exhibits  in  children  due  largely  to  hyperopia  as  a 
primary  cause ;  the  effort  of  accommodation  to  overcome  the  error  involves 
such  demands  on  the  general  nerve  supply  that  other  functions  become  dis- 
turbed. Indigestion  is  one,  bed-wetting  is  another,  mental  irritability  or 
dullness  is  another.  If  a  child  habitually  exhibits  excitability  and  temper, 
with  bed-wetting  look  out  for  convulsions.  Sometimes  they  occur  soon 
after  going  to  bed,  after  which  the  child  sleeps  soundly  until  morning. 
Others  do  not  reach  the  stage  of  convulsion  and  relaxation  until  toward 
morning.  Morning  head-aches  in  children  are  indications  that  there  have 
been  convulsions  during  the  night.  The  Ophthalmologist  can  reach  the 
cause  of  practically  all  of  such  exhibits  in  the  young;  but  when  they  are 
found  in  persons  past  the  age  of  puberty  it  becomes  a  Neurological  case 
and  requires  months  to  remove  the  causes  so  they  will  remain  normal. 

Reference  has  been  made  elsewhere  to  the  bad  effects  of  chromatic 
aberration  in  "toric"  lenses  and  in  "fused"  bifocals.  In  the  latter  the  inset 
portion  is  of  "flint"  glass  which  has  double  the  index  of  dispersion  of  the 
ordinary  glass  used  for  spectacle  lenses  and  wholesale  optical  houses  have 
announced  they  will  not  be  responsible  for  the  aberration,  thus  proving  there 
have  been  many  complaints.  As  to  the  "torics"  one  instance  will  be  sufficient 
to  show  the  damage  which  may  be  caused :  Some  years  ago  I  had  a  case 
of  anisometropia  requiring  4-  4.00  for  one  eye  and  -f--  8.00  for  the  other, 
which  had  been  considered  blind  and  had  not  been  corrected.  I  ordered 
frames  and  had  the  lenses  made  as  thin  as  possible,  bi-convex,  to  avoid 
aberration  and  weight.  The  bad  eye  came  along  all  right  and  in  a  few 
weeks  was  as  good  us  the  other;  both  practically  normal.  The  girl  and  her 
father  were  highly  pleased ;  all  was  well.  A  few  months  later  her  father 
ceased  speaking  to  me.  He  was  a  drinking  man  and  I  supposed  he  was 
tipsy  so  paid  no  attention  to  the  matter.  A  few  days  later  he  began  abusing 
me  in  the  elevator  of  the  building  where  we  had  our  offices ;  he  said  I  had 
put  his  daughter's  eye  out.  I  told  him  to  bring  her  in  and  1  would  replace 
the  one  I  put  out.  That  afternoon  they  appeared  and  both  expressed  them- 
selves vigorously.  Then  I  began  an  examination.  The  first  thing  I  struck  was 
when  I  removed  her  glasses :  I  found  they  were  skeleton  "torics."  I  asked 
where  she  got  them.  She  replied  that  she.  saw  the  advertisement  of  an 
optician,  (who  advertises  with  a  bird's  beak  to  symbolize  his  name),  and 
when  she  called  to  see  him  he  told  her  they  were  the  "last  word  in  lenses." 
I  told  her  I  thought  so  too ;  that  she  would  better  go  and  vent  her  spleen  on 
him ;  that  I  would  have  nothing  more  to  do  with  the  case ;  and  I  showed 
her  and  her  father  the  way  to  the  door  with  the  admonition  to  vacate  and 
do  it  quickly.  From  experience  with  other  cases  I  have  no  doubt  that  the 


ALLEGED  EYE  DISEASES  203 


chromatic  aberration  gave  her  eye  a  set-back;  it  might  have  been  repaired 
and  it  might  not ;  I  took  no  chances  under  the  circumstances  and  at  once  in- 
creased my  fees  so  that  when  I  take  a  case  it  pays  me  enough  at  the  begin- 
ning to  warrant  it  will  stick  to  me  to  the  end. 

Menstrual  derangements  are  such  a  common  exhibit  from  the  nerve 
strain  of  hyperopia  that  parents  should  have  their  daughters'  eyes  examined 
by  a  competent  Ophthalmologist  at  not  later  than  the  tenth  year,  so  that 
the  function  may  come  on  naturally.  Amenorrhoea,  dysmenorrhoea,  men- 
orrhagia,  respectively,  no  flow,  painful  flow  and  too  much  flow  are  the  ex- 
hibits. They  have  puzzled  the  old-school  doctors  always,  and  the  whole 
bunch  have  never  done  as  much  good  with  their  tampons,  curettements. 
etc.,  as  any  one  of  our  graduates  accomplishes  every  year.  The  old  notion 
that  pain  is  a  natural  incident  to  the  function  has  been  knocked  into  a 
"cocked  hat"  by  our  brand  of  Ophthalmology;  and  our  Neurology  even 
carries  the  war  to  the  limit  by  eliminating  the  pains  of  parturition.  Cor- 
rection of  the  eye  errors,  diet,  baths,  manual  treatment  and  education  of 
patients  is  our  armament. 

It  has  always  been  taught  by  the  doctors  and  the  wise  ones  among  the 
laity,  that  after  the  "change  of  life"  in  a  woman,  her  physiological  ills 
usually  disappear;  but  they  always  add:  "provided  she  gets  through  that 
period  with  her  mentality  intact."  The  proposition  appeared  reasonable  be- 
cause it  was  backed  by  exhibits ;  but  when  we  observed  that  men  with 
"grouches"  parted  with  them  at  about  the  same  age  as  the  women,  the 
thought  came  to  us  that  the  cause  was  not  what  had  been  claimed ;  then 
when  we  found  that  by  correcting  the  hyperopia  and  performing  a  few  other 
easy,  natural  repairs  on  the  human  machines,  male  and  female,  we  got  all 
of  the  results  formerly  left  to  Natural  infirmities,  we  thanked  our  heterodoxy 
and  handed  the  evidence  to  our  students. 

Quite  frequently,  in  cases  of  nervous  exhaustion,  the  sphincter  muscles 
controlling  the  mouths  of  the  lachrymal  glands  become  so  relaxed  that  the 
tears  flow  faster  than  the  nasal  ducts  can  carry  them  away.  The  oculists 
call  this  an  operative  case  and  pioceed  to  probe  the  ducts,  sometimes  even 
inserting  tubes.  It  is  not  only  an  exceedingly  painful  procedure  but  it  is 
absolutely  foolish  for  anatomical  and  physiological  reasons  which  any  oculist 
ought  to  know : 

First,  the  structure  of  the  tissue  in  the  canals  is  similar  to  that  of  a 
sponge,  for  the  purpose  of  absorbing  a  reasonable  amount  of  fluid;  then 
the  processes  of  breathing,  coupled  with  body  heat,  cause  evaporation. 

Second,  operation  lacerates  this  structure  and  scar-tissue  forms,  which, 
not  having  the  capacity  for  absorption  the  normal  tissue  had,  makes  it  im- 
possible to  accomplish  good  by  operation.  Putting  in  tubes  is  worse,  be- 
cause, being  foreign  bodies,  Nature  endeavors  to  expel  them  by  the  usual 
process  and  hypertrophy  ensues. 

The  simple  way  to  fix  all  such  cases  is  to  correct  the  hyperopia  and 
build  up  the  system,  when  the  lachrymal  glands  will  work  normally. 

In  cases  of  spasm  of  the  nervous  system  the  mouths  of  the  glands 
often  close  too  tightly  and  do  not  discharge  enough  fluid  to  lubricate  the 


204  A  SYSTEM  OF  MATURE  MEDICINE 

lids,  and  the  eyes  become  dry,  itchy  and  inflamed.  The  same  treatment 
suggested  for  epiphora  will  cause  relaxation  and  correct  the  xerophthalmos. 

The  many  phases  of  alleged  "diseases"  could  not  be  given  comprehen- 
sively in  a  book ;  but  if  the  practitioners  who  read  will  qualify  and  try  what  has 
been  stated  here,  they  will  find  their  confidence  in  Nature  growing,  their 
success  increasing  and  their  worries  decreasing. 

Too  many  physicians  appear  to  be  under  the  impression  that  ophthal- 
mology is  a  branch  of  medicine.  When  questioned  they  admit  they  acquired 
the  belief  because  very  little  was  taught  about  eyes  in  their  schools  and  all 
of  that  was  about  eye  "disease"  requiring  the  attention  of  specialists.  The 
joke  of  it  is  the  specialists  were  their  teachers.  Another  joke  is :  the  teachers 
know  nothing  of  real  Ophthalmology;  they  go  out  and  practice  as  medical 
specialists,  using  cycloplegics  and  the  "code  of  ethics"  to  bunko  a  practice 
out  of  the  field  which  should  be  taken  care  of  by  the  general  practitioner. 
As  the  old  schools  teach  and  practice  it,  ophthalmology  is  a  fraud.  As  we 
teach  and  practice  it,  Ophthalmology  is  a  system  of  practice  as  independent 
of  medical  practice  as  is  dentistry.  As  we  teach  and  practice  Neurology,  or 
Mature  Medicine,  Ophthalmology  is  a  branch  of  it  and  a  very  essential  one. 
As  we  teach  our  work  to  old-school  doctors  Ophthalmology  becomes  a  root 
of  their  work  and  the  most  important  one.  Our  Ophthalmologists  are  not 
practicing  old-school  medicine  and  violating  "law"  when  they  relieve  human 
ills  after  the  old  methods  have  failed.  Statutes  which  have  been  employed 
to  persecute  old-school  competition  have  always  proved  boomerangs  to  the 
persecutors.  We  have  a  supreme  contempt  for  any  man  or  woman  in  any 
trade  or  profession  who  would  invoke  the  aid  of  unfair  "laws"  to  protect 
them  against  competition.  We  regard  such  conduct  as  a  confession  of 
incompetence  which  is  disgraceful. 


CHAPTER  XXIV. 

Objective  and  Subjective  Methods  Employed  in  Eye  Testing. 

More  skill  is  required  to  fit  a  pair  of  glasses  correctly  than  to  perform 
any  major  surgical  operation  ever  attempted. 

Anatomy  is  practically  constant.  Major  operations  are  performed  under 
anaesthesia.  Therefore  surgery  is  simply  a  trade.  Some  surgeons  are  more 
skillful  than  others,  just  as  some  butchers  are  more  "handy"  with  their  tools 
than  others.  The  surgeon  does  his  work.  If  the  patient  survives  it  is  her- 
alded as  a  "triumph  of  science."  If  he  dies  it  is  charged  to  "the  shock  of 
the  anaesthesia,"  to  "neglect  by  patient",  to  "the  will  of  God",  etc. 

Physiology  is  always  an  inconstant.  The  contention  of  oculists  that 
cycloplegics  are  essential  to  good  work  in  fitting  glasses  proves  two  things : 
First,  that  they  do  not  know  the  physiological  relations  between  the  eyes 
and  the  general  system ;  second,  as  a  sequence,  they  believe  that  when  the 
pupils  dilate  and  the  accommodation  is  apparently  paralyzed,  the  obstacles 
are  all  removed  and  finding  the  full  correction  is  like  neutralizing  lenses. 
Their  practices  are  more  condemnatory  than  their  theories,  because :  First, 
they  do  not  practice  what  they  preach,  for  they  do  not  atropize  more  than 
one-half  of  the  patidnts  who  patronize  them;  second,  when  they  find 
patients  do  not  "tolerate"  full  corrections  after  the  effects  of  the  cycloplegics 
have  worn  away,  they  weaken  the  glasses  to  suit  the  pleasure  of  the  in- 
dividual, thus  letting  him  fit  himself,  as  he  might  do  at  a  department  store 
counter;  hence  little  benefit  is  received,  and  sometimes  actual  harm  is  done 
by  their  giving  —  lenses  where  -f-  are  needed. 

"Optometrists",  not  being  licensed  to  employ  drugs  in  their  practices, 
have  gone  as  far  as  they  dared  and  profess  skill  with  the  skiascope,  or 
mirror  test,  which  they  call  an  objective  test,  when  it  is  actually  the  very 
worst  form  of  subjective  test,  because,  the  intense  light  thrown  into  the 
eye  by  the  mirror  irritates  the  optic  nerve  and  it  communicates  with  the 
little  devil  inside,  who  controls  the  iris  and  the  accommodative  apparatus, 
with  the  effect  that  there  is  a  first-class  spasm  in  about  two  seconds,  which 
remains  either  as  a  tonic  or  clonic  exhibit,  during  the  entire  procedure  of 
making  the  alleged  test.  The  "optometrists"  even  go  the  oculists  one  point 
better — they  claim  to  have  a  "dynamic"  skiascopy  which  enables  them  to 
"find  the  errors  of  refraction  without  asking  patients  any  questions,"  and 
while  they  use  their  accommodation  any  old  way.  The  funny  part  of  it  all 
is  that  many  oculists  have  been  deceived  by  the  proposition  and  accept  it  as 


206  A  SYSTEM  OF  MATURE  MEDICINE 

true,  proving  again  their  utter  ignorance  of  the  simplest  principles  of 
physiology.  Oculist  professors  in  the  old  medical  schools  have  given  testi- 
monials to  the  manufacturers  of  retinoscopes  as  accurate  means  of  finding  the 
exact  correction.  A  Philadelphia  professor,  whose  books  "have  been  trans- 
lated into  Chinese,"  according  to  his  own  boast,  has  the  following  to  say 
about  the  value  of  the  method,  all  of  the  quoted  paragraphs  are  on  one  page 
of  his  latest  book : 

''The  wonderful  advantage  of  retinoscopy  over  other  methods  needs  no 
argument  to  uphold  it;  the  rapidly  increasing  number  of  retinoscopists 
testify  to  its  merits." 

"With  an  eye  otherwise  normal  except  for  its  refractive  error,  and  being 
under  the  influence  of  a  reliable  cycloplegic,  there  is  no  more  accurate  ob- 
jective method  of  obtaining  its  exact  correction  than  by  retinoscopy." 

"The  exact  refraction  is  obtained  without  questioning  the  patient." 

"Its  great  value  can  never  be  overestimated  in  cases  of  nystagmus, 
young  children,  amblyopia,  aphakia,  illiterates  and  the  feeble-minded." 

"From  what  has  just  been  stated,  it  must  not  be  understood  that  the 
patient's  glasses  are  ordered  immediately  from  the  findings  obtained  by 
retinoscopy,  for,  on  the  contrary,  all  retinoscopic  work,  like  ophthalmometry 
in  general,  should,  when  possible,  be  confirmed  at  the  trial  case." 

Rather  inconsistent  is  he  not?  First  it  is  exact.  Finally  it  needs  con- 
firmation at  the  trial  case.  He  says  it  is  great  for  nystagmus,  children,  etc. 
Nystagmus  is  an  oscillation  of  the  eyeball  and  he  would  have  no  more  chance 
with  such  a  case  than  the  Dutchman  had  to  catch  his  famous  flea.  Children 
and  feeble-minded  people  will  stare  straight  into  the  mirror  despite  the 
efforts  of  all  the -doctors  in  the  world,  when  nothing  can  be  seen;  beside 
that  they  would  accommodate  just  the  same  as  sane  grown  people,  no  mat- 
ter how  much  dope  was  put  into  their  eyes.  While  this  oculist  knocks  the 
dynamic  skiascopist  by  insisting  on  atropinization,  he  makes  himself  ridicu- 
lous by  contradicting  his  first  assertion  of  exactness  and  by  calling  the  test 
valuable  for  feeble-minded,  etc.  He  couldn't  fit  anyone  of  any  age  or  frame 
of  mind  with  a  mirror.  Nor  can  anyone  else,  for  reasons  which  will  be 
shown  very  shortly. 

"Instruments  of  precision"  is  a  favorite  expression  of  oculist  and  "op- 
tometrist." It  sounds  mysterious  "don't  you  know."  We  even  read  in 
"optometrical"  literature  of  the  "value  of  the  sphygmomanometer  to  the 
"optometrist."  Verily  the  love  of  mystery  is  second  only  to  ego  in  man- 
kind generally. 

The  situation  makes  it  necessary  that  all  of  this  matter  be  handled  with- 
out gloves  or  mincing  of  words.  The  public  pays  too  dearly  for  its  foolish- 
ness in  licensing  classes  of  people  to  practice  professions  and  alleged  pro- 
fessions with  immunity  from  liability  for  the  damage  they  do  and  liberty 
to  persecute  honest  men  and  women  who  are  of  superior  qualifications  but 
who  are  not  in  favor  with  the  powers  that  be.  Few  readers  may  believe  it, 
but  it  is  a  fact,  nevertheless,  that  the  alleged  "laws"  for  the  "protection  of 
the  public"  are  purely  political,  secured  with  exactly  the  opposite  design  by 
those  who  spend  time  and  money  to  get  them  through  the  legislatures.  The 
people  who  father  them  and  the  law-makers  who  pass  them  are  "crooks" 


OBJECTIVE  AND  SUBJECTIVE  EYE  TESTING  207 

if  ever  there  were  any  such  characters.  Take  the  "Pure  Food  and  Drug" 
law,  passed  by  Congress,  for  an  example :  One  of  the  big  promoters  was 
Dr.  Charles  Page,  member  of  the  Medical  Trust,  Boston,  Mass.  He  sent  out 
a  circular  letter  to  all,  or  nearly  all  of  the  doctors  in  the  United  States  urging 
them  to  push  their  representatives  in  Congress  to  pass  the  bill,  promising 
them  that  if  the  job  could  be  done  it  would  put  patent  medicine  manu- 
facturers out  of  business  to  the  tune  of  $165,000,000  annually,  which  neat 
sum  would  then  be  the  plum  to  be  divided  among  the  doctors,  who  pre- 
scribe the  same  old  stuff.  Was  not  that  patriotic? 

I  have  no  use  for  patent  medicines.  I  have  no  use  for  prescription 
medicines.  If  compelled  to  take  one  or  the  other  I  would  take  the  patents, 
because  they  are  made  to  be  harmless,  while  the  average  doctor,  protected 
by  his  license  is  too  much  in  the  habit  of  giving  lethal  doses.  If  the  public 
is  foolish  enough  to  take  either,  I  recommend  the  patent.  Which  is  the 
worst  for  the  victim :  to  take  a  medicine  manufactured  by  a  physician  and 
sold  in  car  lots  to  department  stores,  where  it  sells  at  69  cents  a  quart,  or 
to  take  another,  made  by  non-medical  men  and  sold  to  physicians  and  drug- 
gists in  liquid,  tablet,  pill  and  powder  forms,  at  tremendous  profits,  to  be 
peddled  out  to  the  public  for  other  profits?  Prescriptions  have  caused  more 
people  to  form  opium  and  cocaine  habits  during  the  past  ten  years  than  have 
all  of  the  patents  ever  sold.  It  is  reported  by  Medical  Trust  journals  that 
about  one-third  of  their  own  members  are  dope  fiends  of  one  sort  or  another. 
Are  they  fit  to  be  licensed  and  trusted  with  the  lives  of  citizens  and  their 
children? 

But  worse  than  the  devilish  dope  they  give  in  competition  with  the 
patent  medicines,  is  the  stuff  they  want  to  shoot  into  people  with  hypo- 
dermic syringes.  A  youth  leaves  his  country  or  town  home  and  comes  to 
the  city  to  a  medical  college.  The  first  thing  he  does  is  to  get  into  a  "frat" 
house  to  have  a  good  time.  If  he  was  set  to  work  at  his  studies  as  we  do  in 
our  school  he  would  have  no  time  for  carousals ;  but,  the  number  of  doctors 
is  too  great  and  it  must  be  kept  down  by  keeping  the  rising  generation  in 
school  four  to  seven  years,  while  his  father  and  grandfather  finished  the 
same  work  and  did  it  better  in  two  years.  After  he  has  spent  four  years 
in  one  of  the  old  schools  of  medicine  he  comes  out  absolutely  unfit  for  any- 
thing, because  his  ego  and  prejudice  have  so  deranged  his  brain  cells  they 
inspire  him  to  join  the  A.  M.  A.  (Medical  Trust),  part  his  whiskers  in  the 
middle,  or  trim  them  to  a  point,  look  wise,  carry  his  medicine  ca-se  a  la 
mode — and  starve  to  death  "ethically,"  or,  at  most,  average  $700  a  year. 
They  catch  the  infection  early  too.  Occasionally  a  party  of  "freshies,"  from 
one  of  the  "orthodox"  schools  in  Chicago,  drop  into  our  offices  and  pro- 
pose to  "look  us  over"  and  to  ask  us  to  "explain  our  work"  to  them  in  a 
few  minutes.  I  ask  them  how  long  since  they  were  weaned.  The  kids 
have  natural  talents,  probably,  but  after  they  have  been  in  an  orthodox 
school  a  year  their  highest  ambition  is  to  go  down  "Peacock  Alley"  at  the 
Congress  hotel  and  hold  a  riot;  which  idea  their  professors  encourage  with 
bail  bonds  to  keep  them  out  of  jail.  Fathers,  do  you  want  your  boys  edu- 
cated that  way?  If  you  do  don't  send  them  to  us.  We  do  not  stand  for 
such  nonsense  two  minutes. 


208  A  SYSTEM  OF  MATURE  MEDICINE 

Hero-worship  and  a  craven  desire  to  imitate  somebody  constitute  a, 
baneful  duality.  The  church,  on  the  social  side,  and  the  self-styled  "regular" 
medical  sect,  on  the  professional  side,  have  had  their  day.  Nature  is  too 
big  for  both  and  is  surely  coming  into  the  ascendancy  in  the  very  near  future. 
Progress  is  hampered  by  the  foolish  imitators  of  the  older  sects,  but  they  are 
so  damned  foolish  they  make  the  whole  scene  ridiculous  enough  to  make  the 
dullest  see  through  the  grand  farce. 

It  was  not  medical  science  nor  Christian  science  that  conquered  yellow 
fever  in  Havana,  in  Rio  de  Janeiro  and  other  Southern  cities.  It  was  drainage. 
It  was  not  mosquitoes  that  caused  the  fever.  It  was  swamps,  sewage,  in- 
sanitation,  that  cause  both  mosquitoes  and  noxious  gases,  the  last  of  which 
set  up  acute  malaria  with  malignant  toxaemia  which  killed  thousands,  while 
yet  other  tens  of  thousands  were  killed  by  fear. 

"The    Spirit  of   the    Plague   entered   the   city   gates. 
"One,  watching,   asked :     'How  many   wilt  thou    slay?' 
"  'A  thousand'  quoth  the  Spirit,  and  passed  on. 
"The  Plague  had  ceased ;  the  Spirit  passed  the  gate. 
"The   watcher  cried ;     'Ten  thousand   didst   thou  slay !' 
"  'Nay ;  one.'     the  Spirit  said ;  'Fear  killed  the  rest.' " 

The  rite  of  vaccination  has  produced  dozens  of  new  diseases ;  antitoxin 
has  killed  thousands  by  causing  tetanus.  The  people  know  it ;  yet  when  one 
raises  his  voice  in  protest,  some  newspaper  doctor  will  assert  that  "anyone 
who  disputes  the  efficacy  of  vaccination  needs  an  inquiry  into  his  sanity." 
This  bluff  works  oftener  than  it  fails;  and  if  it  does  not,  the  scamps  figure 
that  they  have  the  advantage  in  publicity  and  in  compulsory  "laws." 

Look  at  the  death  notices  of  "regular"  doctors :  Pneumonia,  cerebral 
hemorrhages,  heart  disease,  cancer,  erysipelas  and  suicide  are  the  principal 
causes  given  in  the  Journal  of  the  American  Medical  Association  every  week. 
Dozens  of  them  under  fifty  years  of  age.  They  can't  even  take  care  of  them- 
selves. They  are  not  good  as  general  practitioners ;  they  are  bluffers  and 
empirics  in  specialties. 

Now,  to  return  to  the  thread  of  our  narrative  in  the  so-called  specialty, 
Ophthalmology.  With  us  it  is  not  a  specialty ;  but  is  a  system  of  general 
practice,  limited,  it  is  true,  to  a  certain  extent,  yet  it  is  more  practical  and 
useful  in  a  general  way  than  any  of  the  "systems"  in  vogue  from  time  to 
time.  It  is  not  a  new  system.  It  is  as  old  as  creation.  We  have  been 
teaching  it  for  twenty-three  years  and  practicing  as  well  as  studying.  What 
we  have  to  say  here  is  all  demonstrable  clinically.  It  will  be  seen  that  it 
could  not  be  done  with  a  retinoscope,  or  any-  other  machine : 

Our  patients  are  all  awake  and  exhibiting  all  sorts  of  symptoms,  from 
inflamed  lids  to  cyclitis ;  from  clonic  spasm  to  cross-eyes ;  from  simple  head- 
ache to  chronic  dyspepsia ;  from  the  amenorrhoea  of  young  girls  to  the  hys- 
teria of  elderly  women ;  and  a  hundred  more  alleged  "diseases"  which  are 
due  primarily  to  nerve  strain  in  the  efforts  to  overcome  hyperopia.  Our 
Ophthalmologists  have  to  know  how  to  find  the  contributing  causes  and  re- 
move them  in  order  to  get  the  desired  results  from  the  glasses.  To  do  all 
this  they  have  to  know  general  anatomy  and  physiology  differently  and  bet- 
ter than  the  old  school  general  practitioners  know  those  subjects.  That  is 
why  our  Department  of  Ophthalmology  is  not  simply  a  leader  of  optical 


OBJECTIVE  AND  SUBJECTIVE  EYE  TESTING  209 

schools  but  is  a  leader  among  general  schools  of  practice.  Our  entire  Neu- 
rological course,  including  Ophthalmology,  of  course,  is  in  a  class  all  alone, 
and  if  others  continue  to  stick  to  their  fanatical  notions  about  long  terms  of 
attendance  and  their  crazy-quilt  methods  of  instruction,  with  their  students 
stuffing  themselves  with  false  notions  of  importance,  Greek  letter  societies, 
etc.,  we  will  always  occupy  the  entire  field. 

The  reader  will  see  already  that  if  we  do  all  we  have  claimed  in  the 
last  paragraph  above,  the  retinoscope,  or  any  other  instrument,  would  not  cut 
much  of  a  figure.     Our  work  embraces  the  duality  objective  and  subjective 
tests.    We  do  not  want  any  machine  that  will  do  the  work  without  our  ask- 
ing  patients   questions.      We   want   to   use   our   brains    and   we   want   our 
patients  to  use  theirs.    Our  subjective  tests  are  not  such  as  the  "optometrist" 
and  oculist  employ.     We  do  not  hold  lenses  in  front  of  the  eyes  and  ask 
patients  "do  you  see  better  with  this,"  as  the  others  say  they  do  in  such 
tests.     We  have  test  cards  and  we  know  what  they  mean.     We  know  the 
value  of  the  distance  represented  by  each  line  of  letters ;  and  we  know  how 
to   measure  those   letters  to  find  if  they  are  of  correct  size.     We  require 
patients  to  read  the  letters  aloud.     We  do  not  permit  them  to  commit  the 
letters  to  memory.     If  any  give  us  such  symptoms  we  require  them  to  read 
the  lines  backwards.    Our  testimony  as  to  what  the  acuteness  of  vision  of  any 
of  our  patients  is  would  be  accepted  as  first  hand  information  in  any  court  in 
the  world.     Yet  the  "optometrist"   calls  it  second-hand  information.     The 
manner  in  which  he  gets  it  is  second-hand ;  but  because  he  does  work  that 
way  is  no  sign  that  subjective  testing  by  others  is  incorrect.     The  oculist 
and  "optometrist"  talk  about  Fogging  as  if  they  knew  how  to  do  it.     As  I 
originated  the  Fogging  System,  and  the  others  admitted  it  long  years  ago  by 
calling  me  "Old  Man  Fog,"  my  rights  are  established.     I  am  ready  now  to 
tell  them  they  know  nothing  about  Fogging.    If  they  will  read  this  carefully 
they  may  get  some  ideas  about  it ;  after  which  I   have  something  else  in 
reserve  for  them : 

First,  merely  putting  on  strong  -\-  lenses  and  reducing  them  with  - 
or  by  changing  the  +  f°r  weaker  ones  from  time  to  time,  until  the  patient 
sees  as  well  with  lenses  as  with  the  naked  eyes,  is  not  fogging. 

Second,  putting  on  strong  -f-  lenses  and  weakening  them  until  vision 
is  as  good  as  possible ;  then  increasing  them  gradually  by  the  changes  until 
the  strongest  the  patient  will  accept  and  see  well  is  found,  is  not  fogging. 

Third,  putting  on  strong  -(-  lenses  and  after  weakening  them  by  several 
changes  in  which,  with  one  —  lens  in  each  hand,  one  a  little  stronger  than 
the  other,  the  second  one  always  gives  the  best  vision,  so  that  the  patient 
has  come  to  expect  it,  the  coming  back  with  the  same  lenses  and  asking  him 
to  read  another  line,  which  he  often  does,  sometimes  suffering  himself  to 
be  deceived  into  relaxing  accommodation  so  that  he  comes  from  20/80  to 
20/20  without  further  weakening  of  the  original  lens,  is  not  fogging.  Some 
who  have  seen  me  do  this  called  it  a  miracle ;  but  when  they  learned  better 
they  knew  that  was  not  fogging;  and  they  knew  that  our  imitators  have 
never  been  able  to  do  this  little  trick. 

Fourth,  having  a  system  of  procedure  which  tests  the  elasticity  of  the 
tissues  and  the  nerve  status,  the  quality  and  quantity  of  nerve  supply,  the 


210  A  SYSTEM  OF  MATURE  MEDICINE 

disposition  and  temperament  of  our  patients,  so  that  we  can  prescribe  Tem- 
porary lenses,  together  with  such  other  instructions,  which,  if  followed, 
will  permit  Nature  to  get  the  general  systemic  conditions  in  form  for  us 
to  complete  our  work,  is  not  yet  fogging. 

Hence  the  joke  is  on  our  imitators,  who  have  written  much  about  fog- 
ging when  they  knew  nothing  whatever  about  it. 

Fogging,  my  lads  and  lassies,  is  what  we  have  been  doing  to  you  all  in 
general,  and  to  those  who  came  to  us  as  students,  in  particular,  for  twenty- 
three  years.  We  have  also  been  fogging  the  public.  Fogging,  my  dears,  is 
Educating  people.  We  have  kept  the  oculist,  "optometrist"  and  optician 
guessing  as  to  what  we  were  going  to  do  next.  Alleged  competing  schools 
have  addressed  correspondents,  telling  them  they  taught  what  we  do.  Re- 
sult, many  of  the  recipients  of  such  letters  came  to  us  to  get  the  subject  at 
first  hands.  The  optical  journals  and  medical  journals  vented  their  spleen 
in  a  manner  that  showed  their  readers  we  must  be  some  pumpkins.  "Opto- 
metrical"  and  medical  speakers  and  writers  criticized  our  conduct  in  shatter- 
ing their  old  idols  and  even  attempted  to  smother  us  with  ridicule.  Oh, 
we  had  'em  Fogged  "to  a  frazzle."  We  had  our  own  papers  and  books 
with  which  to  answer  them,  too,  and  we  have  circulated  those  papers  by  the 
hundreds  of  thousands,  Free,  to  the  General  Public.  We  had  no  advertising 
space  to  sell.  We  had  no  "Kryptogram"  or  "Keytole"  or  "Medicated"  lenses 
to  sell.  We  had  no  "Dynamic-skiasco-meters"  to  dispose  of  to  suckers.  Wre 
simply  paid  the  printer  and  wrote  the  truth  as  we  saw  it  and  could  prove  it. 
We  impressed  some  studious,  ambitious  minds  that  we  were  not  in  this  work 
for  mere  dollars.  We  impressed  them  that  we  knew  what  we  were  talking  and 
writing  about.  Many  who  had  attended  the  alleged  optical  schools,  and  the 
old  schools  of  medicine,  came  to  us  and  took  our  work.  They  got  the  evi- 
dence at  first  hands  and  they  got  the  proofs  so  they  know  how  to  use  them. 
As  another  result  scarcely  a  day  passes  that  we  do  not  receive  letters  from 
all  directions  saying:  "I  have  seen-  the  work  of  your  graduates  and  it  is 
something  marvelous.  Have  you  any  representatives  in  our  vicinity?"  Ah, 
that's  Fogging,  children,  and  "He  who  laughs  last,  laughs  best."  I  will  not 
rub  it  into  my  gentle  adversaries  of  the  past  any  harder. 

Now,  as  the  prestidigitateur  says,  "Watch  my  hand  and  I'll  show  you 
just  how  I  do  it."  The  following  is  the  Fogging  System: 

When  a  patient  comes  into  my  office  it  is  a  pleasant  place,  neatly  but 
not  gaudily  furnished ;  a  polite  lady  is  in  charge  and  knows  who  have  ap- 
pointments so  there  is  no  delay.  If  it  is  a  new  case,  she  arranges  for  an 
examination,  gives  necessary  information  and  collects  the  examination  fee. 
She  uses  her  discretion  in  questioning  prospective  patients  and  saves  much 
time  by  her  reports  to  me.  When  the  patient  gets  into  my  private  office 
he,  or  she,  is  made  as  comfortable  as  possible,  facing  the  window,  while  I 
have  my  back  to  it  so  I  can  study  expressions  of  countenance,  complexion, 
proportions  of  development,  general  physiognomy,  disposition  and  tempera- 
ment. I  invite  confidence  and  become  a  good  listener,  while  the  "tale  of 
woe"  is  recited ;  after  which  I  hold  court  and  cross-question  the  witness ; 
finding,  many  times,  that  some  statements  have  been  too  strong  and  some 
not  strong  enough  ;  all  of  which  is  duly  recorded  as  we  proceed.  Next,  I 


OBJECTIVE  AND  SUBJECTIVE  EYE  TESTING  211 

have  a  distinct  understanding  that  all  of  our  dealings  are  confidential :  that 
I  do  not  discuss  my  cases  with  other  doctors  and  I  do  not  permit  my 
patients  to  consult  other  doctors  or  listen  to  other  people's  comments  about 
the  case  so  long  as  it  is  in  my  charge.  This  saves  a  lot  of  annoyance  from 
meddlesome  Matties.  Next,  I  show  that  there  are  many,  or  few,  contribut- 
ing causes  to  the  conditions  exhibited,  and  that  it  will  be  useless,  or  prac- 
tically so,  to  take  the  case  unless  I  am  to  be  permitted  to  cover  all  of  the 
causes,  thus  insuring  good  results  to  the  patient  and  protecting  the  reputa- 
tion of  Neurology.  Next,  I  use  the  ophthalmoscope  to  ascertain  the  quality 
and  quantity  of  blood  in  the  general  system,  the  number  and  size  of  the 
vessels,  the  relative  number  of  veins  and  arteries,  and  if  there  are  any 
local  visible  pathological  signs  or  anatomical  freaks,  I  find  them.  I  use  the 
direct  method  always;  then  I  see  the  real  things  right  side  up.  My  mys- 
tery-loving brothers  argue  for  the  indirect  method,  because  they  have  not  yet 
been  Fogged  enough.  Incidentally  I  get  close  enough  to  the  patient  to  note 
the  body  odors,  if  any  exist — and  I  know  what  they  mean — also  the  odors 
from  the  nasal  passages  and  the  mouth ;  I  know  how  to  distinguish  between 
catarrh,  bad  teeth,  whisky,  tobacco,  cigarettes,  chewing  gum  and  a  sweet, 
healthy  breath.  Next,  I  listen  to  the  heart  and  lung  action — I  wouldn't 
give  a  damn  a  dozen  for  stethoscopes  and  sphygmomanometers ;  I  keep  my 
ears  clean  and  in  working  order ;  I  can  stick  a  stethoscope  against  a  brick 
wall  and  hear  rales  and  murmurs.  I  know  what  good  heart  and  lung  action 
is ;  hence  I  know  what  bad  action  is.  I  also  know  that  a  lot  of  the  so-called 
bad  action  according  to  accepted  "authorities"  is  nothing  more  than  the 
simple  product  of  eye  strain.  I  have  had  many  a  case  of  "mitral  valve 
disease"  and  "tobacco  heart"  that  proved  to  be  nothing  more  than  a  natural 
result  of  excessive  nerve  demand  for  the  eyes.  I  have  also  often  found 
such  patients  wearing  --  lenses  of  considerable  power  when  they  needed  -f- 
lenses  of  greater  power,  hence  they  were  in  a  worse  condition  with  their 
lenses  on  than  without.  I  have  found  them  wearing  compound  lenses  for 
near  work  only  when  anyone  with  brains  enough  to  drive  geese  to  water 
should  know  that  anyone,  under  about  forty-five  years  of  age,  who  needs 
glasses  for  near  work  needs  them  for  constant  wear,  and  that  anyone  who 
has  astigmatism  should  wear  glasses  constantly.  Next,  I  take  the  acuteness 
of  vision  of  each  eye  separately  and  make  a  record  of  it  for  reference 'during 
the  test  and  for  future  use.  If  my  patient  reads  the  20  line  at  20  feet  I 
know  vision  is  normal ;  but  I  do  not  know  the  eye  is  normal ;  I  know  it  is 
not  myopic ;  but  it  may  be  very  hyperopic.  If  only  20/30  or  worse  is  re- 
corded, it  may  be  myopia,  or  hyperopia  without  accommodative  power 
sufficient  to  overcome  it ;  it  may  be  myopic  astigmatism,  hyperopic  astigma- 
tism, mixed  astigmatism,  retinal  atrophy  or  hypertrophy.  If  it  is  20/15 
or  better  I  know  it  means  at  least  1.00  D.  hyperopia  and  possibly  as  much 
as  2.50 ;  and  I  know  there  is  no  astigmatism  worth  looking  for,  because  I 
know  that  a  whole  diopter  of  error  in  an  eye  only  changes  the  principal 
focal  point  about  a  quarter  of  a  millimeter,  hence  a  quarter  of  a  diopter 
of  astigmatism  would  only  change  the  focal  distance  in  one  meridian  a 
quarter  of  a  quarter  of  a  millimeter,  or  1/16  mm.,  hence  would  not  impair 
vision.  I  know  the  chaps  who  talk  and  write  about  correcting  one-eighth 


212  A  SYSTEM  OF  MATURE  MEDICINE 

diopters  error  need  more  fogging.  Next,  I  make  a  dynamic  test  of  the  nerve 
supply ;  some  call  it  testing  the  accommodation,  but  they  have  no  tables  or 
other  records  to  go  by  and  the  test  is  not  worth  anything.  The  Neurometer 
is  based  on  this  and  other  tests.  I  know  exactly  how  much  my  patient 
should  show  to  be  normal;  I  know  about  how  much  is  going  to  be  shown; 
but  I  make  no  guesses ;  I  make  the  test  and  record  it.  Then  comes  the  static 
test,  which  is  an  involuntary  nerve  test ;  it  is  a  check  on  the  dynamic  one  and 
if  it  disputes  that  test  I  believe  it  most  until  the  other  is  supported  in  the 
final  analysis.  This  test  is  made  with  a  double  prism  so  placed  in  front  of  the 
left  eye  that  two  lights  are  seen  where  there  is  only  one  at  the  usual  testing 
distance  of  15  or  20  feet,  and  they  must  be  in  a  perfectly  vertical  position ; 
I  place  on  the  right  eye  a  dark  disk  and  behind  it  a  colored  glass,  usually  red, 
but  any  color  will  do,  as  I  must  be  able  to  know  for  sure  which  eye  is  seeing 
the  light  that  should  be  in  line  with  and  midway  between  the  other  two.. 
If  the  red  light  is  seen  out  of  position,  on  the  right,  it  indicates  a  weak  nerve 
supply  generally  and  it  is  exhibiting  through  the  third  nerves  by  way  of  the 
internal  recti  muscles ;  if  it  is  out  of  position,  on  the  left,  it  indicates  nerv- 
ous irritation  to  the  point  of  tonic  spasm,  and  the  exhibit  is  by  way  of 
the  same  nerves  and  muscles  as  before ;  if  it  is  out  of  position,  above  or 
below  the  mid-point,  but  in  line  with  the  white  lights,  it  is  an  indication 
of  an  irregular  distribution,  exhibiting  by  way  of  the  superior  and  inferior 
branches  of  the  third  nerves  to  the  superior  and  inferior  rectus  muscles; 
if  it  is  out  of  position  obliquely  on  the  left,  it  is  an  erratic  distribution  with 
a  tonic  spasm ;  if  out  of  position  obliquely  to  the  right  it  is  erratic  dis- 
tribution with  a  tendency  to  weakness,  and  we  record  the  exhibit  for  use 
in  the  final  tests  and  in  analyzing  the  case  by  the  Neurometer. 

All  of  the  symptoms  exhibited  in  these  several  tests  are  preliminaries 
which  could  not  be  found  in  any  other  manner.  No  instrument  or  machine 
would  even  approximate  them.  Without  them  no  one  could  proceed  with  a 
search  for  the  amount  of  the  refractive  error  with  any  hope  of  certainty. 
Some  of  them  are  objective  and  some  are  subjective.  To  be  able  to  make 
these  tests  without  ( knowing  their  full  significance  would  not  avail  the 
practitioner  a  particle.  They  are  not  available  to  us  until  after  we  have 
made  the  refraction  test  and  have  repeated  the  three  last  tests,  mentioned 
in  the  preceding  paragraph,  with  the  correction  found  before  the  eyes.  Then 
we  make  our  calculations  as  described  in  the  chapter  on  the  Neurometer, 
making  certain  additions  for  physiological  demands  and  certain  other  ad- 
ditions for  temperament,  then  certain  discounts  for  symptoms,  when  the 
final  figures  tell  us  whether  we  have  something  near  the  correction  of  the 
error,  and  also  tell  us  exactly  the  condition  of  the  patient.  In  seventy-five 
per  cent,  of  all  cases  we  find  it  necessary  to  order  temporary  lenses  which 
stop  the  nerve  strain  through  the  eyes  while  we  attend  to  the  contributing 
causes  of  the  entire  situation.  This  is  what  makes  our  Ophthalmology  a 
system  of  general  practice,  while  the  alleged  systems  employed  by  all  others 
are  "merely  fitting  glasses,"  under  conditions  which  render  it  an  impos- 
sibility to  find  anything  approaching  the  real  amount  of  the  error ;  and  if 
they  could  find  the  full  amount  and  prescribed  it,  patients  would  not  get 
more  than  partial  results  because  the  contributing  causes  have  been  ignored. 


OBJECTIVE  AND  SUBJECTIVE  EYE  TESTING  213 

"Dynamic  skiascopy"  would  be  a  joke  were  it  not  that  its  advocates  take 
themselves  seriously  and  the  public  are  the  victims  of  misguided  practices. 
In  other  chapters  it  has  been  explained  that  the  eyes  in  their  static  condition, 
that  is  with  their  accommodative  apparatus  at  rest,  exhibit  the  minimum 
-f-  power;  that  the  nervous  system  is  so  sensitive  that  the  pupils  close 
automatically  the  instant  the  light  becomes  uncomfortable ;  that  the  nerves 
which  operate  the  iris  also  operate  the  accommodation;  that  continued  ac- 
commodative efforts  are  always  accompanied  by  reduction  in  size  of  the 
pupils ;  that  any  test  which  may  involve  the  accommodation  as  an  antagonist 
is  a  subjective  test.  In  the  last  point  mentioned  we  have  the  reason  retino- 
scopy  is  not  an  objective  test.  As  shown  in  Chapter  XII  the  theory  of 
retinoscopy,  as  a  physical  proposition,  is  all  right.  But  we  stated  there 
that  physiologically  it  is  a  colossal  humbug.  Here  are  the  proofs : 

An  emmetrope,  looking  at  a  point  20  feet  away  would  have  to  accom- 
modate one-sixth  of  a  diopter  to  see  clearly;  hence,  an  operator  working 
at  one  meter  would  find  the  reversal  point  with  +  .83%.  The  "experts" 
always  claim  they  find  it  with  -f-  1.00,  showing  they  do  not  even  know  the 
theory  of  their  business.  As  a  matter  of  actual  fact,  they  often  find  — 
lenses  necessary  to  reverse  the  shadow,  as  we  have  found  many  of  their 
victims  wearing  —  lenses  when  they  needed  strong  +.  A  hyperope  looking 
at  20  feet  would  accommodate  the  amount  of  his  hyperopia  and  one-sixth  of 
a  diopter  more,  making  him  present  exactly  the  same  proposition  to  the 
observer  as  the  emmetrope  did ;  even  if  the  hyperope  relaxed  his  accommoda- 
tion in  order  to  see  at  the  distance  with  the  -f-  lenses  he  would  not  be  nearly 
so  liable  to  relax  it  while  a  fierce  light  is  being  thrown  into  it  as  if  there 
was  no  distributing  factor  present.  A  myope  cannot  see  at  20  feet  until 
-  lenses  are  put  on,  and  when  that  is  done  there  will  be  accommodation  for 
the  same  reason  there  was  in  hyperopia,  namely,  the  excess  light ;  hence 
more  -  -  would  be  demanded  and  we  find,  invariably,  myopes  are  sadly 
overcorrected,  which  makes  them  hyperopes,  and  hyperopes  are  sadly  un- 
dercorrected,  even  to  being  given  —  lenses,  which  increases  their  hyperopia. 
A  Chicago  retino-medico-optometrist,  who  is  regarded  as  a  great  teacher 
by  the  unsophisticated,  all  over  the  country,  advises  full  corrections  in  myopia 
and  under-corrections  for  hyperopes.  He  has  also  "seen"  latent  myopia; 
he  told  me  so  himself.  His  fund  of  misinformation  is  only  equalled  by  an- 
other Chicago  "optometrist"  who  says  he  has  a  "method  of  fitting  hyperopia 
and  myopia  with  the  ophthalmometer,"  known  only  to  himself,  and  by  a 
California  "optometrist"  who  knows  we  are  all  wrong  when  we  say  the 
images  on  the  retinae  are  inverted  and  reversed. 

To  anyone  who  has  the  slightest  knowledge  of  the  nervous  system  and 
of  physical  and  physiological  optics  and  ophthalmology,  the  "dynamic  skias- 
copy" story  is  too  ridiculous  for  further  mention ;  but,  as  nearly  everyone 
engaged  in  the  practice  of  "optometry"  and  oculistry,  know  so  little  of  the 
fundamentals  that  they  are  mislead  by  those  who  have  the  nerve  to  make  a 
pretense  of  knowing,  a  little  more  space  will  be  devoted  to  the  dymanics :  A 
patient  who  is  not  most  thoroughly  under  the  influence  of  a  cycloplegic,  (and 
it  is  dangerous  to  life  to  attempt  to  put  one  in  that  condition,  as  all  oc- 
ulists who  argue  for  "reliable"  cycloplegics  are  compelled  to  admit),  will 


214  A  SYSTEM  OF  MATURE  MEDICINE 

use  his  accommodation,  under  any  test,  as  naturally  as  he  will  use  his  lungs ; 
therefore  any  test  of  the  dioptric  system  stimulates  accommodative  effort, 
no  matter  how  mild  it  may  be ;  and,  of  course,  any  test  with  which  the 
patient  is  entirely  unfamiliar,  such  as  throwing  a  beam  of  light  into  the 
eye,  will  be  especially  aggravating.  It  invariably  brings  on  a  tonic  or  clonic 
spasm  and  deceives  the  operator  every  time.  The  pretense  of  some  that  they 
have  a  way  of  having  the  patient  fix  on  different  points  while  they  make  the 
test  from  different  distances  and  thus  corroborate  one  test  with  another  is 
pure  "bunk,"  too  silly  to  be  considered,  because  if  they  could  fit  a  case  at 
one  distance  they  could  do  it  at  another,  hence  would  not  need  to  experi- 
ment. Some  of  those  fellows  who  have  been  taunted  by  their  friends  with 
my  invitation  to  come  to  my  office  and  fit  me  and  one  other  with  glasses, 
correctly,  and  receive  therefor  the  sum  of  $500,  have  replied :  "Who  is  going 
to  decide  when  the  job  is  done  correctly?"  and  the  bluff  appears  to  have 
worked,  from  all  I  can  hear.  Now,  let  it  be  understood  that  any  person 
who  thinks  he  knows  how  to  prove  his  work,  as  those  selfsame  fellows  say 
they  do,  when  they  are  talking  to  the  public,  or  to  "optometrist"  suckers, 
should  bring  that  knowledge  with  him  and  come  after  me.  They  do  not 
appear  to  realize  how  illogical  they  are.  By  our  system  we  prove  our  work 
absolutely  before  we  discharge  a  patient.  It  appears  they  know  so  little 
that  they  do  not  imagine  it  is  possible  to  prove  anything.  I  fear  they  are 
so  ignorant  I  could  not  show  them  the  simple  laws  which  prove  they  are 
mistaken,  unless  I  could  have  them  with  me  several  weeks  and  first  teach 
them  the  optical  alphabet.  One  set  of  chaps  who  came  after  the  money  once, 
declared  in  the  presence  of  witnesses  that  if  a  person  can  see  as  well  through 
a  +  -50  lens  as  through  a  +  2.00  it  proves  it  is  as  good  a  correction.  The 
man  who  made  that  declaration  is  today  a  licentiate  in  Illinois  by  "ex- 
emption." 

Optical  houses  who  advertise  retinoscopes,  ophthalmometers,  ametropo- 
meters,  etc.,  as  "instruments  of  precision"  know  they  are  liars  when  they 
do  it  just  as  they  are  liars  when  they  tell  our  prospective  students  that 
we  work  people  to  death  in  our  school.  They  dare  not  say  we  haven't  a 
good  school ;  but  they  do  not  like  us  because  we  do  not  encourage  our 
students  to  load  themselves  down  with  debts  and  such  instruments.  We  do 
recommend  that  each  student  possess  and  use  an  ophthalmoscope ;  one  cost- 
ing $4  is  as  good  as  is  made  and  is  never  out  of  order  when  wanted,  as  the 
"luminous"  ones  often  are.  We  recommend  a  good  trial  set ;  the  one  I 
devised  many  years  ago  is  most  convenient ;  and  there  is  not  a  "sott-markee" 
in  it  for  us  whether  they  buy  that  style  or  not.  We  tell  our  students  that 
a  comfortable  operating  chair  is  worth  a  wagon  load  of  instruments ;  that  for 
purposes  of  study  and  profit  in  information,  a  clinical  thermometer  is  a  con- 
venience, as  are  also  a  urinometer  and  a  stethoscope;  but  they  are  not 
absolute  necessities,  as  are  the  ophthalmoscope  and  test  lenses.  An  office 
scale  for  taking  weights  and  measuring  heights  of  patients  and  a  smaller 
scale  for  weighing  foods  are  great  conveniences. 

There  are  no  "instruments  of  precision"  except  those  with  purely 
physical  functions,  and  few  of  such  are  absolute.  Our  method  of  pro- 
cedure with  the  eyes  is  much  the  same  as  our  method  of  making  general 


OBJECTIVE  AND  SUBJECTIVE  EYE  TESTING  215 

examinations ;  it  is  systematic  and  we  only  arrive  at  final  conclusions  after 
we  have  had  the  case  in  charge  until  its  physiological  capacity  for  adjust- 
ments has  adapted  itself  to  the  new  situations  and  the  symptoms  of  disorders 
have  disappeared  entirely.  Then  and  not  before,  we  have  the  proofs  that 
our  work  is  correct.  We  endeavor,  during  eye  tests  to  induce  the  accom- 
modative power  to  reverse  its  engines,  that  is,  to  relax  and  reveal  the  full 
error ;  but  it  occurs  only  when  the  patient  is  of  such  an  age  that  presbyopic 
tendencies  enable  us  to  settle  the  matter,  and  even  then  we  often  insist 
upon  second  and  third  visits.  We  do  not  employ  cycloplegics  because : 
First,  they  are  both  dangerous  and  unreliable ;  second,  even  when  they  take 
partial  effect  they  interfere  with  our  repeating  tests  after  we  have  finished 
our  refraction  test ;  third,  many  people  object  to  them  not  only  because  of  the 
discomforts  they  produce,  but  they  know  those  who  use  them  do  it  for  ad- 
vertising purposes  at  their  patients'  expense;  fourth,  we  have  a  method  that 
is  decidedly  satisfactory  to  ourselves  and  our  patients. 

The  machines  used  for  testing  the  refractive  qualities  of  eyes  are  all 
makeshifts  and  the  subjective  ones  are  dynamic,  two  faults  which  render 
them  unreliable.  They  are  expensive  and  using  them  consumes  valuable 
time  which  can  be  utilized  to  advantage  in  proceeding  by  our  method. 

Many  of  them  were  devised  by  authors  for  the  purpose  of  impressing 
their  colleagues  and  the  public  with  their  alleged  knowledge  of  the  subject. 
The  others  are  made  by  manufacturers  to  sell  at  enormous  profits.  If  any 
doctor  wants  to  try  one  all  he  need  do  is  to  advertise  for  a  second-hand 
one  and  he  will  be  flooded  with  replies  from  those  who  have  learned  by  ex- 
perience the  truth  of  my  statement. 

The  prisoptometer  was  one  of  the  first  ones.  It  is  made  with  a  revolving 
double  prism  and  a  target  four  inches  in  diameter,  to  be  placed  at  a  speci- 
fied distance  and  the  patient  is  to  tell  the  operator  when  the  two  targets, 
seen  through  the  prisms,  are  touching,  lapping,  or  separated.  The  first 
is  said  to  indicate  emmetropia,  the  second  myopia  and  the  third  hyperopia. 
If  there  is  astigmatism  the  targets  may  touch  at  one  position  and  lap  or 
separate  at  another,  as  the  prisms  are  revolved ;  or  they  may  lap  or  separate 
at  one  position  and  lap  more  or  separate  more  at  another ;  or  they  may  lap 
at  one  position  and  separate  at  another,  indicating  respectively,  simple,  com- 
pound, and  mixed  astigmatism.  The  bad  feature  of  the  machine  is  that 
it  is  the  most  "subjective"  of  all  known  "instruments,"  because  the  operator 
is  compelled  to  let  the  patient  decide  the  matter  without  previous  experi- 
ence ;  and,  as  a  matter  of  fact,  no  operator  could  ever  become  sufficiently 
expert  to  measure  his  own  errors,  for  the  simple  reason  that  none  can  tell 
when  the  two  targets  are  just  touching. 

The  retina-ophthalmoscope  which  has  been  so  vigorously  advertised  dur- 
ing the  past  eighteen  years,  was  first  made  from  a  pattern  constructed  from 
ordinary  mailing  tubes  by  the  writer,  who,  by  that  means,  satisfied  himself 
of  the  impossibility  of  machines  ever  being  practical.  The  contrivance  was 
thrown  into  a  closet  and  lay  for  months,  when  one  day  the  head  of  the 
optical  house  exploiting  them  came  to  visit  me  and  suggested  that  I  get  up 
a  machine  and  they  would  make  it.  I  produced  the  apparatus  and  gave  it  to 
him  with  the  injunction  that  I  would  not  care  to  have  my  name  attached  to 


216  A  SYSTEM  OF  MATURE  MEDICINE 

it.  So  it  was  named  for  a  noisy  oculist  who  was  prominent  at  that  time 
and  a  great  many  of  them  were  sold.  As  I  could  not  endorse  it  and  was 
placed  in  a  position  where  I  had  to  denounce  it,  by  the  claims  of  retinoscope 
fiends,  the  friendship  and  business  relations  of  my  school  and  the  firm  were 
broken. 

All  other  subjective  machines,  whether  for  testing  the  refraction  or 
other  eye  exhibits,  are  of  no  practical  value  to  the  operator  who  understands 
his  business.  When  the  argument  is  offered  that  "it  is  a  good  thing  with 
which  to  get  a  quick  idea  of  the  nature  of  the  condition"  it  tells  at  once 
that  the  speaker  or  writer  hasn't  the  faintest  idea  of  practicing  according 
to  a  system.  No  rational,  educated  Ophthalmologist  cares  whether  it  is 
hyperopia  or  myopia  he  is  going  to  deal  with ;  he  regards  it  as  a  waste  of 
time  to  powwow  around  a  patient  with  mirrors,  machines  or  lassoes.  He 
has  all  the  facilities  he  needs  in  his  trial  set,  his  ophthalmoscope  and  his 
training. 

The  objective  machines  are  represented  in  the  various  ophthalmometers, 
or  keratoscopes.  There  are  several  of  them,  all  constructed  on  the  same 
principles,  of  course.  One  of  their  weaknesses  is  that  the  radius  of  the 
curve  of  the  surface  on  which  the  mires  are  placed  is  fixed  and  the  radii  of 
eyes  to  be  tested  are  not;  another  is  the  difficulty  patients  have  in  holding 
the  eyes  in  position,  in  proof  of  which  statement  one  has  only  to  test  an 
eye  several  times  in  succession;  another  is  it  is  a  monocular  instrument; 
another  is  that  while  the  principal  meridians  of  an  astigmatic  eye  may  be 
found,  the  amount  of  the  error  is  very  indefinite,  and  even  the  meridians 
located  may  be  oblique  during  the  test,  but  when  the  correction  of  the  eyes 
is  completed  they  will  be  found  vertical  and  horizontal. 


CHAPTER  XXV. 

Situation  in  Emmetropia,  Hyperopia  and  Myopia,  with  Lens  Removed. 

Aphakia  means  absence  of  the  crystalline  lens.  It  presents  some  inter- 
esting conditions  for  calculation  : 

We  found,  page  95,  that  the  power  of  the  crystalline  lens,  in  its  posi- 
tion, in  Emmetropia,  is  19.737  diopters  of  the  total  63.00  diopters  com- 
prised in  the  entire  system. 

Removing  the  lens  from  such  an  eye  leaves  the  center  of  curvature  of 
the  cornea  as  the  optical  center  and  all  nodal  points. 

The  radius,  divided  by  the  excess  index,  gives  F'  and  adding  the  radius 
to  F'  gives  F2  ;  hence  : 

R,   7.84-f-  .3365  =  23.298%   F',+R,   7.84  =  31.138%   F2. 

A  ray  starting  from  the  posterior  pole,  22.86  from  the  cornea,  divergent 
from  the  axis  would  still  be  divergent  after  refraction  by  the  cornea,  be- 
cause the  distance,  22.86,  multiplied  by  the  opposite  principal  focal  distance, 
23.298%,  and  the  product  divided  by  the  difference  between  22.86  and  the 
near  principal  focal  distance,  31.138%,  gives  a  negative  focal  distance  of 
64.3349,  thus: 

22.86X23.298%  =  532.60752 


22.86-31.138%=      8.278% 

Placing  a  correcting  lens  5.6651  mm.  from  the  cornea  and  adding  that 
amount  to  the  distance  found,  gives  70  mm.  or  14.25  D.  as  the  lens  required. 

It  might  be  believed  that  if  the  eye  had  been  hyperopic  or  myopic  1.00 
diopter  the  above  figure  would  require  1.00  more  or  less;  but  that  is  not  so. 

Suppose  the  refracting  system  to  have  been  normal  before  removal  of 
the  lens,  but  the  eye  was  flattened  posteriorly  enough  to  cause  1.00  D. 
hyperopia.  That  means  the  combined  dioptric  power  of  cornea  and  lens 
would  have  to  be  64.00  D.  or  15.625  from  optical  center  to  put  focus  on  the 
retina.  Adding  the  distance  from  optical  center  to  the  cornea,  6.988,  gives 
22.613  mm.  as  the  antero-posterior  length  of  the  eye;  and,  proceeding  as  be- 
fore: 

22.613X23.298%  =  526.852749  - 

22.613-^31.138%=     8.525%    =  63'3619  negative  F. 
Adding  the  same  distance  from  cornea  to  lens  as  before,  we  have  : 

63.3619+5.6651  =  69.027   mm.   or   14.48   D.   lens   required. 
Now  suppose   the  cornea  is  deficient  1.00  D.  but  the  antero-posterior 
length  of  the  eye  is  normal,  22.86.    That  means  a  62.00  D.  eye,  with  a  focal 
distance  of  16.129  from  the  optical  center.    Adding  the  distance  from  optical 


218  A  SYSTEM  OF  MATURE  MEDICINE 

center  to  cornea,  6.988,  gives  23.117  as  the  distance  from  the  cornea  to  the 
principal  focal  point,  with  the  retina  .257  mm.  in  front  of  it,  or  22.86  from 
the  cornea. 

The  deficiency  being  in  the  cornea,  the  first  principal  focal  distance  of 
which  is,  normally,  23.298%  or  42.93  D.,  to  find  the  radius  necessary  for  the 
calculation:  Deduct  1.00  D.  from  'the  normal,  leaving  41.93  D.  with  a  first 
principal  focal  distance  of  23.849  mm.  This,  multiplied  by  the  excess  index, 
.3365,  will  give  the  radius  : 

F',  23.849X.3365  =  8.025  =  R,  and 
F'    23.849+R,   8.025  =  31.874=  F2 

The  distance  from  the  retina  to  the  cornea  is  22.86,  and,  as  the  lens  is 
out,  we  are  dealing  with  a  single  curved  surface  again  : 

22.86  X23.84<9  —  545.18814  .         ,         ,     ,.    ,  A   ...  .        ,.    . 

—          j_  —  r-rrr-     =  60.482  negative  focal  distance.    Adding  the  distance 

«  <S  •  CTU^^O  1  .  O  I  4    -  «7.l/14 

from  the  cornea  to  the  lens  outside  as  before:  60.482-[-5.  6651  =  66.147  mm. 
or  15.08  D.,  the  lens  required. 

A  myope  of  1.00  D.,  with  the  error  in  his  cornea,  would  have  the  focus 
.235  mm.  in  front  of  his  retina,  because  his  total  power  of  cornea  and  lens 
would  be  64.00  D.  or  15.637  mm.  Removing  the  crystalline  lens  would  make 
him  hyperopic.  His  cornea,  having  1.00  D.  too  much  power,  is  44.93  D.. 
with  22.256  F',  which  multiplied  by  the  excess  index  gives  the  radius  : 

F',  22.256X-3365  =  7.489  =  R,  and, 

F',  22.256+R,  7.489  =  29.745  =  F2. 

The  distance  of  retina  from  cornea  being  22.86  : 

22.86X22.256  —  508.772         .,„  0  r  ,.    .  A,,.  ,.    , 

=73.88    negative    focal    distance.     Adding   the    distance 


-..  _ 

.  i  40  - 

from  cornea  to  lens  as  before  : 

73.88+5.6651  =  12.57  D.  +  lens  required. 

If  the  myope's  eye  was  bulged  posteriorly,  causing  the  error,  the  dioptric 
system  being  normal,  the  condition  presented  would  be  one  calling  for 
62.00  D.  or  16.129  mm.  focal  distance  from  the  optical  center.  Adding  the 
distance  from  optical  center  to  cornea  : 

16.129+6.988  =  23.117  antero-posterior  length  of  eye.  Using  the  normal 
radius  and  F  of  cornea,  we  have  : 

23.117X23.298%  —  538.595  „..  .    ,,-          „,         ,.    . 

"'      '7?  neSatlve  focal  'K^ncc.     Adding  the  distance 


23.117  —31  138%=8  021% 

from  cornea  to  lens,  as  before  : 

66.72+5.6651  =  72.38    mm.    or    13.81    D.    +    lens    required. 


CHAPTER  XXVI. 


Seeing,  Hearing,  Smelling,  Tasting,  Matters  of  Education. 

There  is  a  popular  belief,  taught  in  the  public  schools  and  elsewhere, 
that  there  are  five  senses :  Feeling,  Hearing,  Seeing,  Smelling  and  Tasting. 
The  same  "authorities"  teach  that  simple  arithmetic  is  divided  into  four 
parts :  Addition,  Subtraction,  Multiplication  and  Division,  when,  truly,  there 
are  but  two  grand  divisions,  because  multiplication  and  division  are  only 
short  methods  of  addition  and  subtraction. 

Feeling  is  sensation,  experienced  by  vegetable  and  animal  matter,  pur- 
suant to  natural  laws.  Applying  the  duality  system  we  have : 


(  General 


Feeling 


Mental    

(Natural    

Instinct 
Thought 
Emotions 
Prejudices 
Heat 
Cold 
Protection 
Identification 
Attraction 
Repulsion 
Selection 
Guidance 
Form 
Color 
Audition 
Information 

Acquired    

.   Physical     
f  Chemical    

I  Temperature    
Touch    

f  Smell    

I  Taste 

(Seeing    

Mechanical    .  .  . 

Hearing       

Special 


As  usual,  the  third  subdivision,  to  eighths,  brings  out  the  chief  points 
to  be  considered ;  the  last  column  being  added  merely  as  suggestions. 

This  chapter  was  suggested  by  the  ludicrous  efforts  of  various  in- 
dividuals to  explain  why  we  see  objects  as  they  are  instead  of  inverted  and 
reversed  as  their  images  are  in  the  eyes. 

Figures  Em.,  My.  and  Hy.  are  printed  to  show  how  the  eyes  form  pic- 
tures just  as  an  ordinary  camera  does;  the  only  differences  being  that  the 
dioptric  apparatus  of  the  eye  combines  a  single  curved  surface  with  the  lens, 
and  the  retina,  corresponding  to  the  sensitized  plate  of  the  camera,  is  curved 
instead  of  flat.  In  the  cuts  the  refraction  of  the  lens  is  ignored.  It  is  put 
in  only  to  locate  the  optical  centers,  o,  at  which  points,  approximately,  the 
secondary  axial  rays,  2  and  3,  cross  the  principal  axes,  passing  from  T  and- 
B  on  the  objects,  O,  to  T  and  B  at  the  retina  in  Em,  in  front  of  it  in  My, 
and  behind  it  in  Hy.  The  object,  O,  is  to  be  regarded  as  at  infinity  and  the 
accommodative  apparatus  at  rest  in  all  three  eyes. 


220  A  SYSTEM  OF  MATURE  MEDICINE 

It  is,  of  course,  understood  that  the  Emmetrope  needs  only  one-sixth 
of  a  diopter  of  accommodation  to  see  clearly  at  6  meters,  hence  it  is  not 
worth  considering;  the  Myope  could  not  improve  his  vision  by  accommodat- 
ing, because  that  would  cause  the  image  to  be  formed  farther  in  front  of 
the  retina,  and  vision  would  be  worse,  therefore  he  would  not  make  such 
effort;  but  the  Hyperope,  by  employing  his  accommodation  and  increasing 
the  power  of  his  crystalline  lens,  could  cause  the  images  to  be  formed  at  the 
retina. 


With  the  object  at  infinity,  the  Emmetrope,  Fig.  Em,  receives  a  clear 
image  on  the  retina  inverted  and  reversed.  The  point  at  T  on  the  retina  is 
produced  by  rays  coming  from  T  on  the  object;  the  same  is  true  of  the 
points  at  B  and  on  the  axis  of  the  eye.  Each  is  absolutely  independent  of  the 
others.  This  would  also  be  true  if  there  were  rays  shown  from  object  to 
image  at  every  point;  those  above  the  axis  at  the  object  would  focus  below 
that  line  at  the  retina,  those  on  the  right  would  focus  on  the  left,  etc.;  but 
each  would  be  independent  of  the  others.  The  image  is  as  much  smaller 
than  the  object  as  the  distance  from  o  to  the  retina,  15.872  mm.,  is  smaller 
than  that  from  o  to  the  object,  6000  mm.,  or  about  1/378.  Thus  the  ordinary 
test  type  for  6  meters  is  8.7  mm.  square,  and  this,  divided  by  378,  gives  an 
image  at  the  retina  23/1000  mm.  square  ;  or  something  like  a  period  on  this 
page.  Yet  the  nervous  system  is  able  to  receive  and  deliver  these  small 
images  to  the  brain  in  separate  points,  and,  what  is  still  better,  deliver 
duplicate  impressions  from  the  two  eyes  so  that  the  corresponding  points 
on  the  two  retinae  deliver  as  a  single  impression.  Printers  call  that  a 
"perfect  register." 

What  happens  next  is  Education.  This  is  acquired  by  experience  and 
by  instruction.  The  meaning  of  such  impressions  is  limited  to  the  mental 
capacity  of  the  animal  or  person.  For  example,  the  reader  is  familiar  with 
the  impressions  conveyed  to  his  brain  by  these  lines  ;  but  let  him  tackle 
the  next  one,  without  turning  the  page: 


T8  W*  *&&  P"      tjufex.  JJff2  (o   issrg 


The  pictures  on  your  retinae  and  the  impressions  in  your  brain  are  just  the 
same  as  they  are  on  the  retinae  and  in  the  brain  of  the  printer.  The  only 
difference  is  his  education.  Here  is  another  illustration  : 


These  periods  and  dashes  appear  to  your  eye  and  your  brain  just  as 


SEEING,  HEARING,  ETC.,  A  MATTER  OF  EDUCATION 


221 


they  do  to  any  other  eye  and  brain,  excepting  the  telegraph  operator's,  who 
will  at  once  recognize  the  alphabet  in  his  language,  "the  Morse  code. 

The  chaps  who  attempt  to  explain  the  "phenomena  of  vision"  by  de- 
claring the  "optic  nerve  is  twisted  en  route  to  the  brain"  will  have  to  tell 
us  what  happens  between  the  ears  and  the  brain  when  the  operator  reads 
this  code  by  sound  even  more  readily  than  by  sight — for  the  simple  reason 
that,  is  his  customary  manner  of  working ;  in  other  words  he  is  better  edu- 
cated to  the  sound. 


In  Fig.  My.  the  rays  pass  the  dioptric  system  as  in  Emmetropia,  but  the 
retina,  being  too  far  away,  the  image  is  formed  in  the  vitreous  humor,  after 
which  the  rays  pass  on  to  the  retina,  as  shown,  divergent  from  the  points  on 
the  image,  so  that  at  the  retina  there  are  minute  circles,  diffused,  instead  of 
points,  hence  an  indistinct  message  is  sent  to  the  brain,  and  if  the  myopia 
is  very  great,  or  the  object  looked  at  is  small,  the  message  will  be  in- 
distinguishable. 

Lest  the  aforesaid  "chaps"  refuse  to  believe  there  is  a  picture  formed 
in  the  vitreous  humor  of  the  myope,  the  following  experiment  is  suggested : 

Take  a  -f  3.00  lens  and  hold  it  one  meter  from  an  ordinary  electric  bulb, 
lighted ;  then  hold  a  piece  of  white  paper  one-half  meter  beyond  the  lens, 
when  it  will  exhibit  a  picture  of  the  light,  inverted,  and  smaller  than  the 
object.  Now  take  another  -f-  3.00  and  hold  it  one-half  meter  farther  away; 
remove  the  paper  to  a  point  one  meter  beyond  the  second  lens  and  there 
will  be  a  picture  of  the  aerial  image  first  found  between  the  lenses,  which 
was  only  two-thirds  of  the  size  of  the  object;  and  the  new  picture  will  be 
the  size  of  the  original  object.  It  is  thus  proved  invisible  things  can  be 
photographed. 


Fig.  Hy.  shows  where  rays  would  focus  and  form  a  clear  image  for  the 
hyperope,  if  his  eye  were  longer.  As  it  is  the  rays  do  not  come  near  forming 
points  at  the  retina,  hence  his  brain  receives  deceptive  impressions  even  to 
the  point  of  incomprehensiveness.  I  am  at  that  stage  of  presbyopia  when  I 
can  no  longer  overcome  my  hyperopia,  and  even  the  largest  letters  on  the 


222  A  SYSTEM  OF  MATURE  MEDICINE 

test  card  are  dim  to  me ;  I  only  know  them  by  reason  of  my  familiarity 
with  letters ;  but  below  "that  I  can  read  nothing.  A  few  years  ago  I  could 
read  normally  without  glasses,  because  I  could  increase  the  power  of  my 
crystalline  lens  with  my  accommodative  apparatus,  and  pull  the  focus  and 
image  forward  to  the  retina. 

Were  it  not  for  this  accommodative  apparatus  every  person,  except 
emmetropes,  would  have  to  use  two  pairs  of  glasses,  one  for  distance,  and 
one  for  near  work :  and  if  the  near  points  were  various,  there  would  be 
needed  various  powers  of  glasses.  We  presbyopes  require  but  two  pairs  on 
account  of  a  limited  capacity  for  accommodation. 

The  color  sense  is  a  subject  which  is  considered  in  another  chapter, 
but  it  is  not  out  of  place  to  remark  here  that  I  have  known  people  who 
could  differentiate  colors  by  the  sense  of  touch,  which  ought  to  settle  the 
Young-Helmholz  theory  that  ''the  retina  possesses  three  sets  of  color- 
perceiving  elements." 

The  special  senses  of  smell  and  taste  send  impressions  to  the  brain  as 
positive  as  those  sent  by  way  of  the  eyes  and  ears.  Each  sense  has  its  own 
function,  and  all  are  necessary  to  the  perfect  enjoyment  of  life ;  yet  when  one 
is  deficient  the  others  can  take  its  place  in  a  measure,  because  of  a  natural 
similarity,  association,  interdependence  and  the  possibilities  of  education. 

The  senses  of  taste  and  smell  are  closely  allied.  Boiled  cabbage,  for  ex- 
ample, tastes  like  it  smells ;  many  fruits  and  other  things  exhibit  similarly. 
The  sense  of  hearing  is  intensified  by  seeing  a  person's  lips  move  in  speaking. 
People  who  are  blind  and  deaf  manage  to  get  along  very  well  with  the  other 
two  senses,  by  educating  them  to  a  higher  efficiency  than  normal.  Some 
are  without  the  senses  of  taste  and  smell,  yet  they  are  cleanly  and  conduct 
themselves  so  few  if  any  would  discover  their  deficiencies. 

If  people  generally  could  be  educated  to  a  proper  appreciation  of  their 
gifts  from  Nature  they  would  take  better  care  of  them. 


CHAPTER  XXVII. 


Fitting  Spectacle  Frames  an  Important  Matter. 

Properly  fitted  lenses  are  ^i^dt  savers  of  nerve  strain;  but  the  job  is 
incomplete  unless  they  are  in  the  correct  positions  before  the  eyes.  This 
conduces  not  only  to  the  good  effects  of  the  lenses,  but  to  the  appearance 
and  mental  comfort  of  patients. 

The  system  of  frame  bending  in  vogue  at  optical  houses  and  tolerated 
by  indifferent  ophthalmologists,  oculists  and  "optometrists"  is  a  purely 
commercial  one —  the  prescription  houses  get  extra  pay  for  disfiguring  peo- 
ple. As  a  rule  there  is  twice  as  much  wire  in  a  nose-piece  as  is  necessary 
and  all  the  bending  anyone  can  do  will  never  help  the  appearance. 

After  many  years  of  vain  endeavor  to  induce  the  prescription  houses 
to  make  a  change  which  could  not  fail  to  bring  them  increased  prescription 
business,  we  decided  to  attend  to  the  matter  ourselves.  Our  first  step  was 
to  have  sets  of  fitting  frames  constructed  to  order.  It  was  decidedly  difficult 
to  make  ourselves  understood  by  the  manufacturers  at  a  distance  of  a 
thousand  miles,  but  we  finally  succeeded  fairly  well.  There  is  room  for 
improvements  in  some  respects,  which  will  be  made  as  soon  as  we  can 
find  time  to  visit  the  factory  personally.  We  are  not  in  the  optical  trade, 
except  with  fitting  frames  and  bridges,  and  only  temporarily  with  them. 
We  will  drop  them  as  soon  as  the  plan  is  adopted  by  a  sufficient  number  of 
optical  concerns  to  supply  our  graduates  and  others  who  want  them.  The 
frames  are  gold-filled  with  solid  gold,  10k.  bridges.  The  bridges  for  skeleton 
spectacles  are  10k.  gold. 


Set  of   Eleven 
Gold     Filled 
Frames 
Solid     Gold 
Bridges 
Ten     Dollars 

Dimensions  of  Fitting  Frames  (Table  1). 

No. 

p.  a 

Bridge 

HiRh 

Bridge 

Wide 

Bridge 

Deep 

Bridge 
1  Crest 

Between 
Lenses 

Sizes 

of  Lenses 

Temple 
Length 

A     Revolution 
in     Bridge 
Making 

A 
B 
C 
D 
E 
F 
G 
H 

1 

Mm. 
54 
55 
56 
57 
58 
59 
60 
61 
62      • 
63 
64 

Mm. 
2 
3 
3 
4 
5 
6 
4 
5 
3 
3 
3 

Mm. 
12 
13 
13$ 
14 
15 
16 
16} 
17     i 
18 
19 
20 

Mm. 
4 
4 
4 
4 
4 
4 
4 
6 
3 
3 
3 

Mm. 
2  Back 
2  Back. 
2  Back 
2  Back 
on  Plane 
1  Ford 
2  Back 
on  Plane 
3  Back 
3  Back 
3  Back 

Mm. 
17 
17$ 
18$ 
19 
19$ 
20J 
21 
21$ 
22$ 
23 
23} 

1  Eye 
1  Eye 
1  Eye 
0  Eye 
0  Eye 
O  Eye 
00  Eye 
00  Eye 
00  Eye 
000  Eye 
000  Eve 

6    inch 
6    inch 
6    inch 
6$    inch 
6$    inch 
6£    inch 
7    inch 
7    inch 
7    inch 
7    inch 
7    inch 

You     Save 
Money 
You    Please 
Patients 

We    will    sup- 
ply    skeleton 
bridges    to 
match. 
See    Table    2 

Table   1  is   self-explanatory,   except   that  there  is  a   tag  on  each   frame 


224 


A  SYSTEM  OF  MATURE  MEDICINE 


(also  on  the  skeleton  bridges)  bearing  the  letter  indicating  the  article  de- 
sired. Those  who  have  used  them  have  found  not  only  an  improvement  in  the 
appearance  of  patients,  but  also  a  saving  of  cost.  We  supply  the  set  of 
eleven  fitting  frames  for  $10  and  single  frames  at  90  cents  each,  in  any 
quantity.  Some  of  the  bridges  are  soldered  to  the  eye  wire  above  the 
pupillary  line  and  in  using  the  corresponding  bridges  for  skeletons  the  holes 
must  be  drilled  above  the  pupillary  line,  of  course.  Each  bridge  shank  is 
adjustable  one  millimeter  in  or  out,  so  that  pupillary  distances  may  be 
changed  when  desired  without  altering  the  appearance  of  patients.  If  a 
case  needs  the  bridge  crest  farther  back  than  is  found  in  the  set,  take  one 
with  a  lower  crest  and  tilt  the  shanks  down,  this  will  raise  the  crest  and  set 
it  back.  Skeleton  lenses  should  be  one  size  larger  than  is  indicated  for  the 
frames  in  Table  1.  Eye  glasses  should  be  one  size  smaller  than  spectacles 
for  the  same  person. 


Skeleton  Bridges  and    Pupil  Distances   (Table  2). 

Note  Bridge 

A 

B 

C 

D 

.E 

F 

G 

H 

I 

J 

K 

en  | 

<u  g 

o 

JS    01 

bog 
,gJ 

Bridge  Bate 

Mm. 
12 

Mm. 
13 

Mm. 
134 

Mm. 
14 

Mm. 
15 

Mm. 
16 

Mm 
164 

Mm. 
17 

Mm. 
18 

Mm. 
19 

Mm. 
20 

Between  Censes 

.    17 

17J 

184 

19 

194 

204 

21 

2H 

22* 

23 

234 

Mm. 

54. 

54.5 

55.5 

56. 

56.5 

57.5 

58. 

58.5 

59.5 

60. 

60.5 

1 

37. 

55.5 

56. 

57. 

57.5 

58. 

59. 

59.5 

60. 

61. 

61.5 

62. 

0 

38.5 

Pupillary 
Distance* 

57. 
58. 

57.5 
58.5 

58.5 
59.5 

59. 
60. 

59.5 
60.5 

60.5 
61.5 

61. 
62. 

61.5 
62.5 

62.5 
63.5 

63. 
64. 

63.5 
64.5 

00 

000 

40,- 
41. 

61.5 

62." 

63. 

63.5 

64. 

65. 

65.5 

66. 

67. 

67.5 

68. 

0000 

44.5 

62.4 

62.9 

63.9 

64.4 

64.9 

65.9 

66.4 

66.9 

67.9 

fS.4 

68.9 

Jumbo 

45.4 

Table  2  is  very  easily  comprehended:  Suppose  bridge  D  is  found,  by 
the  fitting  set,  to  be  the  suitable  one,  and  a  59  mm.  pupil  distance  is  wanted, 
refer  to  Table  2  D,  drop  down  the  column  under  it  to  59,  then,  horizontally, 
over  to  the  right,  in  the  column  "size  of  lenses"  and  00  eye  will  be  found. 
If  a  60  mm.  pupil  distance  is  wanted  and  000  eye  is  obviously  too  large,  the 
shanks  may  be  bent  in  one-half  millimeter  each  and  00  eye  used.  Note  that 
with  a  D  bridge  the  "distance  between  lenses"  is  19  mm.,  the  "length  of  lens" 
00  eye  is  40,  total  59,  the  pupil  distance.  We  supply  these  bridges  in  any 
quantity  at  60  cents  each. 

Nose  bridge  should  not  extend  down  on  the  sides  of  the  nose,  because 
they  mark-  the  nose  badly  and  appear  cumbersome.  We  have  had  many 
students  and  patients  who  were  made  to  appear  ten  years  younger  by  one 
of  these  bridges. 

Another  important  point  is  with  reference  to  length  of  spectacle  temples. 
They  should  be  long  enough  to  go  clear  around  the  ear  until  they  almost 
show  below,  viewed  from  a  position  in  front,  then  they  should  be  light 
weight  and  they  will  never  hurt  the  ears.  Cable  temples  and  all  sorts  of 
devices,  except  long  temples,  have  been  tried  without  relief  from  the  ear 
hurting.  We  solved  that  problem  twenty  years  ago. 


CHAPTER  XXVIII. 
General  Disorders,  Symptoms  of  which  are  called  "Diseases." 

There  are  many  contributing  causes  of  discomfort,  after  the  nerve  strain 
of  hyperopia,  which  the  Ophthalmogist  should  be  familiar  with,  in  order  to 
get  the  best  results  from  his  eye  work.  Indeed  no  doctor  would  be  a  true 
Ophthalmologist  without  this  knowledge,  and  that  is  where  our  graduates 
are  infinitely  superior  to  those  from  any  other  school. 

Abscesses  are  anything  from  a  pimple  to  a  carbuncle.  They  are  caused 
by  wrong  living,  coincidental  with  physiological  strain  through  the  eyes, 
and  the  manner  in  which  they  are  caused  is  the  precipitation  of  solid  matter 
in  the  blood  and  lymphatics.  It  may  only  interfere  with  a  few  capillaries 
and  develop  a  pimple ;  it  may  obstruct  several  large  vessels,  involving  Nature 
in  the  task  of  building  new  vessels  around  it,  and  this  process  develops  a 
hypertrophy  which  is  called  a  boil,  when  it  occurs  in  ordinary  connective 
tissue,  and  a  carbuncle  when  it  occurs  in  the  muscle,  where  lots  of  nerves 
are  involved.  Such  things  should  never  be  lanced,  but  should  be  treated 
with  hot  baths  and  poultices,  which  bring  them  to  a  head  quicker;  when 
the  little  yellow  spot  appears  at  the  apex,  it  may  be  opened,  if  it  does  not 
open  itself,  by  using  an  ordinary  needle,  after  which,  instead  of  pressing  on 
the  lump,  as  most  people  do,  with  the  liability  of  bruising  it  and  making  it 
worse,  the  proper  way  is  to  put  the  thumbs,  one  on  either  side,  and  pull  from 
each  other;  this  puts  an  even  pressure  where  it  should  be,  and  will  often 
bring  out  the  "core."  If  this  does  not  happen  the  first  trial,  do  not  crowd 
matters,  but  let  it  rest  and  boil  some  more ;  then,  instead  of  using  peroxide, 
have  a  little  atomizer  containing  strong  salt  water,  put  the  nozzle  into  the 
opening,  then  press  the  bulb ;  give  it  plenty,  as  it  is  an  antiseptic,  and  will 
help  soften  the  obstructions ;  also  being  absorbed  to  some  extent  by  the 
blood,  it  tends  to  prevent  further  infection.  In  the  meantime,  people  with 
such  exhibits  should  be  kept  on  a  strict  fruit  diet,  preferably  citrus  fruits, 
such  as  lemons,  limes,  grape  fruit,  oranges ;  if  berries  are  in  season,  straw- 
berries are  particularly  good.  All  breakfast  foods,  potatoes,  bread  stuff, 
(except  Southern  corn),  pastry,  sugar,  butter,  should  be  cut  out.  To- 
matoes, string  beans,  cauliflower,  egg  plant,  lentils,  asparagus,  may  be  eaten, 
with  fish,  fowl,  eggs,  and  almost  any  kind  of  meat,  lean,  well  cooked,  would 
be  a  proper  diet  after  the  fruit  has  been  continued  for  a  week.  Our  object 
in  this  book,  and  in  our  school  work,  as  well  as  in  our  practice,  is  to  teach 
the  public  how  to  live  in  comfort,  and  without  the  expense  of  doctors  un- 
necessarily. Of  course,  there  are  a  great  many  complications  which  require 


226  A  SYSTEM  OF  MATURE  MEDICINE 

professional  attention,  but  if  the  people  can  be  induced  to  learn  to  live  right 
they  will  avoid  needless  expense  and  the  suffering  incident  to  acute  exhibits, 
which  are  nearly  always  from  bad  habits,  and  are  so  automatic  in  their  action 
that  they  put  people  temporarily  out  of  business,  by  taking  away  appetites 
and  forcing  them  to  stop  work  and  seek  relief,  which  would  come  in  many 
cases  if  there  was  not  a  doctor  in  the  county.  It  has  always  been  the  policy 
of  the  old  schools  to  keep  the  people  in  ignorance,  so  that  it  would  make 
business  for  them.  The  daily  papers  have  column  after  column  of  alleged 
"free  information,"  which  is  either  deliberately  paid  advertising  by  the 
Medical  Trust,  or  the  papers  are  made  victims  of  what  the  American  Medi- 
cal Association  calls  its  "Press  Bulletin."  This  is  not  an  irresponsible  charge 
against  the  Trust.  We  can  prove  it  by  the  reports  of  members  of  com- 
mittees of  the  A.  M.  A.  made  at  the  National  meeting  of  the  Association  in 
Detroit  in  June,  1916.  The  "Health  Editors"  of  the  big  papers  may  be  paid 
salaries  by  the  owners,  but  it  is  most  probable  that  they  work  for  nothing, 
for  the  personal  advertising  they  get,  and  it  is  possible  they  are  paid  by 
the  Medical  Trust.  There  is  occasionally  a  little  truth  in  what  they  print, 
but  nearly  all  of  it  is  deliberate  encouragement  to  people  to  eat  that  which 
tastes  good,  on  the  presumption  Nature  gave  us  our  tastes,  and  that  each 
knows  what  is  good  for  him  by  his  taste.  Anyone  of  common  sense  ought 
to  know  that  is  a  deliberate  falsehood.  Children  are  given  sweets  and  other 
"goodies"  by  parents  who  they  think  love  them,  with  the  result  that  they 
acquire  a  taste  for  those  things,  just  as  they  would  acquire  a  taste  for 
alcohol,  and  it  is  a  lot  worse  because  it  starts  them  wrong,  they  develop 
bad  teeth  and  bad  stomachs,  and  are  dwarfed  in  growth  not  only  physically 
but  mentally.  In  families  where  Neurology  is  practised  from  infancy,  the 
children  develop  natural  tastes,  the  variety  of  food  given  them  promotes 
growth  in  furnishing  the  essential  body  elements,  and  they  eat  less  quantity 
because  of  the  variety,  hence  digestion  is  better,  and  they  are  not  only 
healthy  but  bright  mentally.  In  connection  with  this  they  are  not  told 
fairy  stories,  bible,  or  other  lies,  but  are  taught  anatomy,  physiology,  math- 
ematics, and  whatever  of  the  arts  they  exhibit  a  capacity  for,  with  the  re- 
sult they  develop  common  sense  and  judgment  early  in  life,  and  make  bet- 
ter citizens.  The  method  of  living  practiced  heretofore  has  developed  mental 
abscesses,  as  well  as  physical  ones,  so  that  we  have  people  of  low  tendencies ; 
some  become  criminals  because  of  the  doctrines  of  forgiveness  that  have 
been  taught,  while  others  develop  the  "reformer"  craze,  with  the  general 
result  that  we  have  a  state  of  chaos  in  society.  We  are  desirous  of  pro- 
moting thought  and  reason,  which  will  insure  fairness  in  dealings  between 
man  and  man,  and  eliminate  the  ever-growing  tendency  to  domination  by 
force.  The  prevailing  religion  of  the  "civilized"  world  is  unnatural,  cruel, 
and  disgusting.  It  forbids  covetousness,  yet  promotes  it;  it  forbids  bearing 
false  witness,  yet  practices  it;  it  forbids  adultery,  yet  promotes  marriage 
purely  for  sexual  purposes ;  it  forbids  murder,  yet  the  States  practice  it 
"legally."  All  of  these  things  come  properly  under  the  title  "abscesses." 
We  have  not  space  in  this  book  to  tell  all  we  know  about  it,  but  we  chal- 
lenge any  investigator  to  controvert  a  single  statement  we  have  made. 

Some  people  suffer  habitually  from  pyrosis,  which  is  commonly  known 


GENERAL  DISORDERS  CALLED  "DISEASES"  227 

as  "acidity"  of  the  stomach.  Even  the  alleged  scientific  doctors  have  been 
deceived  into  believing  that  it  is  the  nitrogenous  elements  in  foods  which 
produce  this  symptom.  They  ought  to  know  better,  and  it  may  be  possible 
that  they  deliberately  stick  to  the  carbohydrate1  theory,  in  the  face  of  its  utter 
failure  covering  a  period  of  several  generations,  for  the  purpose  of  promoting 
illness  for  commercial  reasons.  Any  sufferer  from  acidity  may  try  the 
dietary  suggested  in  the  first  paragraph,  and  thus  obtain  absolute  proof  that 
the  old  story  is  wrong.  Of  course,  if  there  is  any  eye  trouble,  it  should  be 
corrected ;  and,  if  there  are  probable  complications  of  causes,  all  of  them 
should  be  removed,  in  order  to  secure  perfect  results ;  but  there  is  nothing 
in  the  nitrogenous  diet  that  is  harmful ;  it  is  almost  impossible  to  eat  too 
much  of  it  for  the  simple  reason  that,  when  one  has  eaten  a  sufficient  amount, 
the  appetite  is  satisfied,  and  if  any  should  continue  eating  after  that,  they 
will  find  it  palls  on  the  taste,  sets  the  teeth  on  "edge,"  and  -may  even  nau- 
seate. The  feeling  of  hunger  commonly  exhibited  is  located  in  the  stomach, 
and  some  people  say  they  are  still  hungry  after  they  have  eaten  a  hearty 
meal.  Any  "chump"  ought  to  know  that  is  not  hunger,  and  almost  any 
person  who  thinks  ought  to  conclude,  without  any  other  suggestions,  that 
the  sensation  is  a  call  for  help  to  digest  what  is  already  in  the  stomach. 
Those  who  live  Neurologically  never  experience  that  sort  of  hunger;  if  they 
are  busy  and  happen  to  neglect  taking  nourishment,  they  find  their  "think- 
er" is  not  working  up  to  standard ;  when  they  recall  they  have  neglected 
eating,  and  attend  to  that  matter,  they  find  the  brain  goes  to  work  natural- 
ly; thus  they  soon  learn  minds  are  given  to  us  primarily  for  the  purpose  of 
taking  care  of  our  physical  and  physiological  bodies.  The  habit  of  eating 
is  worse  than  the  drug  habit,  liquor  habit,  tobacco  habit,  and  all  other 
habits  combined,  with  the  possible  exception  of  the  talk  habit,  which  is  the 
vilest  thing  that  ever  afflicted  humanity.  Let  any  reader  take  note  of  the 
talk  of  the  next  dozen  people  he  meets ;  he  will  find  that  the  dominating 
feature  is  gossip ;  next  to  it  comes  ego.  Among  young  people  of  the  first 
class,  that  is  children,  the  ambition  for  amusement  prevails,  which  is  good 
because  it  involves  exercise,  and  all  the  guidance  they  need  is  training  to 
keep  them  from  harming  themselves  and  others.  The  second  stage,  youth, 
from  the  age  of  puberty  to  manhood  and  womanhood,  that  is  from  the 
fourteenth  to  the  twenty-fifth  year,  the  principal  topic  is  "trade-lasts,"  that 
is,  swopping  compliments;  they  may  have  to  work  for  a  living  but  few  of 
them  give  much  thought  to  their  work,  and  as  soon  as  they  can  break  away 
they  hunt  company.  In  our  physical  analyses,  described  elsewhere,  we  do 
not  add  for  temperament  in  figuring  on  patients'  conditions  until  after  they 
pass  this  stage  of  life.  This  is  not  a  fad  or  opinion,  but  is  a  statistical  fact. 
Of  course,  there  are  occasional  exceptions  where  we  find  people  are  mature 
men  and  women  at  the  age  of  eighteen,  and  we  learn  this  fact  by  taking  their 
dynamic  test  with  its  age  showing,  adding  the  amount  indicated  for  the  eye 
errors,  then  taking  the  total  from  the  patient's  actual  age,  which  gives  the 
temperament  without  any  exercise  of  judgment  on  our  part.  We  hold, 
metaphorically,  that  such  mental  conditions  are  largely  due  to  the  physical 
ones,  and  that  "acidity,"  so-called,  of  the  physical  body  also  develops  an 
analogous  condition  mentally,  at  any  age.  Now  for  the  acidity :  It  is  not 


228  A  SYSTEM  OF  MATURE  MEDICINE 

what  the  word  implies  in  the  popular  acceptance  of  the  term,  and  what  some 
doctors  evidently  believe,  because  they  give  alkalies,  such  as  bi-carbonate  of 
soda,  as  treatment.  There  is  a  gastric  ferment  which  is  natural,  and  which 
is  acid,  combining  hydrochloric,  sulphuric,  phosphoric,  and  other  acids ;  if 
there  is  not  enough  of  the  active  elements  to  handle  the  basic  ones  properly, 
there  will  be  an  attempt  to  form  a  normal  acid  combination,  but  it  will  fail, 
because  of  absorption  by  the  bases,  and,  instead  of  developing  normal  diges- 
tion, the  process  becomes  merely  one  of  spoiling,  just  as  food  stuff  spoils 
in  the  garbage  can  in  the  alley,  developing  poisonous  chemical  combinations, 
which  in  themselves  are  bad  for  the  system,  but  they  also  create  gases, 
which  give  pain,  "gastralgia,"  and  bloating  of  the  stomach  and  bowels.  We 
do  away  with  all  of  this  by  first  giving  for  immediate  relief  either  an  emetic 
which  empties  the  stomach,  or  one-half  to  one  teaspoonful  of  dry  table 
salt,  on  the  tongue,  and  wash  it  down  with  a  glass  or  two  of  water,  when 
the  action  of  the  chlorine  set  free  starts  normal  digestion;  then  by  cutting 
out  two  or  three  meals,  and  instructing  the  patient  how  to  live  afterwards, 
there  is  no  more  trouble.  The  carbohydrate  story  is  that  a  proper  food  com- 
prises from  four  to  five  parts  of  carbonaceous  matter  to  one  of  nitrogenous. 
It  has  been  claimed  by  the  old  schools  that  any  more  nitrogenous  matter 
is  dangerous,  and  that  even  with  a  proportion  of  one  to  four  or  five,  it 
often  causes  a  "uric  acid  diathesis,"  developing  "rheumatism,"  and  other  ills, 
all  of  which  is  sublime  nonsense.  When  we  get  one  of  their  "chronic" 
rheumatics,  which  they  have  pronounced  "incurable,"  we  put  them  on  a 
wholly  nitrogenous  diet  for  weeks,  and  with  good  results,  with  no  other 
medicines,  except  baths,  manipulations,  eye  corrections,  and  mental  instruc- 
tion. Of  course,  such  cases  as  the  last  mentioned  are  Neurological  cases, 
hence  not  for  the  Ophthalmologist,  further  than  to  correct  eye  errors,  and 
advise  in  a  general  way,  when  they  will  receive  some  benefit;  but  to  insure 
success,  they  need,  by  reason  of  their  long  established  condition,  a  general 
chemical  over-hauling.  Volume  II,  to  follow  this  one,  next  year,  will  treat 
of  such  things  in  detail. 

Albuminuria  is  also  called  nephritis,  and,  after  a  certain  stage  is  reached, 
Bright's  disease.  In  the  chapter  on  "alleged  eye  diseases"  will  be  found  in- 
structions as  to  what  the  ophthalmologist  is  to  do  when  he  finds  the  symp- 
toms. It  is  a  Neurological  case,  strictly. 

Alcoholism,  see  Habit. 

Amenorrhoea  means,  literally,  the  absence  of  the  menstrual  function.  It 
may  never  have  appeared  when  it  should,  or  it  may  have  begun  and  stopped 
for  various  reasons,  one  of  which  will  always  be  found  to  be  Hyperopia. 
In  addition  to  the  correction  of  the  eye  defects,  such  patients  should  be  given 
instructions  with  reference  to  restricting  themselves  to  the  -}-  class  of 
food;  they  should  take  frequent  hot  baths,  and  hot  vaginal  douches,  just 
before  retiring  at  night;  if  the  water  is  made  very  salty,  it  will  have  a 
tendency  for  good.  If  after  a  month  or  so  the  menses  do  not  appear,  or  if 
at  the  examination  the  patient  measures  below  the  safety  line,  and  does  not 
come  above  it  within  a  fortnight,  she  should  be  sent  to  a  Neurologist. 

Anemia  means  a  deficiency  in  the  quality  and  quantity  of  the  blood  and 


GENERAL  DISORDERS  CALLED  "DISEASES"  229 

it  is  always  associated  with  neurasthenia,  a  nervous  debility.  When  this 
occurs  in  girls  between  the  age  of  puberty  and  mature  womanhood,  it  is 
called  chlorosis,  which  simply  means  general  debility  of  both  blood  and 
nerves.  Many  of  these  cases  are  handled  successfully  by  our  Ophthal- 
mologists, and,  by  means  of  the  Neurometer,  they  always  know  just  what 
they  are  doing.  This  class  of  cases  is  to  be  differentiated  from  so-called 
organic  disease,  in  which  there  are  derangements  from  a  complication  of 
causes,  chemical  and  mechanical,  which  Ophthalmology,  being  practically  all 
mechanical,  cannot  reach,  hence  must  send  to  those  qualified  to  treat  suc- 
cessfully. 

Angina  Pectoris,  commonly  known  as  "strangle  heart."  As  a  matter  of 
fact  there  is  not  any  such  a  thing  as  heart  disease,  although  according  to  the 
Journal  of  the  American  Medical  Association  about  15  per  cent,  of  their 
doctors,  whose  cause  of  death  is  reported,  are  recorded  as  from  that  trouble. 
We  have  found  that  nearly  all  of  it  is  indigestion  of  the  acute  sort,  and  the 
balance  is  due  to  eye  strain,  and  contributing  causes,  which  irritate  and 
deplete  the  nerve  supply.  We  have  had  hundreds  of  cases,  and  have  never 
had  a  single  failure  when  instructions  were  followed,  and  they  usually  are.  The 
tenth  cranial  nerves  run  directly  to  the  lungs,  stomach  and  heart,  and  the 
eleventh  go  there  largely,  while  the  spinal  nerves  contribute  to  the  solar 
plexus,  which  is  a  sort  of  abdominal  brain  for  the  evident  purpose  of  regulat- 
ing the  delivery  of  current  to  the  various  organs,  and  as  the  cranial  nerves 
all  originate  in  practically  the  same  place,  any  irritation  from  the  eyes  would 
be  felt  quicker  by  parts  partially  or  wholly  supplied  by  the  cranial  nerves. 

Aphthae  is  sore  mouth,  and  its  presence  indicates  indigestion,  involving 
the  lymphatic  system  particularly.  Ophthalmologists  often  meet  such 
cases,  and  as  a  part  of  their  eye  work  is  to  relieve  nerve  strain  in  every 
direction,  it  is  obvious  they  must  instruct  such  people  with  reference  to 
what  to  eat,  and,  in  order  to  aid  the  lymphatic  system  to  throw  off  the 
poisons,  there  should  be  frequent  hot  baths  to  the  sweating  point.  In  this 
connection  it  is  advisable  to  suggest  that  the  water  be  cooled  until  it  is 
chilly,  and  a  dash  of  cold  water  down  the  back,  after  the  bath,  is  a  good 
thing  to  prevent  further  sweating  after  the  person  goes  to  bed;  and  they 
should  not  put  too  much  cover  on  for  the  first  half  hour  after  retiring.  In 
connection  with  aphthse,  pyorrhea  is  sometimes  found.  This  is  commonly 
known  as  consumption  of  the  gums,  and  dentists  have  been  taught  that  it  is 
incurable.  So  is  everything  else  incurable  so  far  as  remedies  other  than 
those  supplied  by  natural  processes  are  concerned,  but  if  such  people  will 
change  their  diets  to  the  strictly  nitrogenous,  and  use  plenty  of  strong  salt 
water  in  the  mouth,  dipping  a  wet  tooth  brush  in  dry  salt,  and  scrubbing 
the  teeth  inside  of  the  mouth  and  out,  together  with  having  a  dental  ex- 
amination for  bad  roots,  after  treating  themselves  a  week  or  two,  they  will 
almost  invariably  correct  the  trouble. 

Apoplexy  is  a  product  of  high  living.  Excessively  fat  people  are  the 
commonest  sufferers,  but  it  is  not  because  they  are  fat.  It  is  because  the 
same  thing  that  made  them  fat  made  their  nervous  and  muscular  systems 
weak,  so  that  the  blood,  particularly  in  the  vessels  of  the  brain,  becomes 
congested  from  lack  of  vascular  wall  elasticity,  puts  pressure  on  motor  nerves 


230  A  SYSTEM  OF  MATURE  MEDICINE 

and  out  they  go.  There  is  a  popular  belief  that  a  person  does  not  last 
through  more  than  two  or  three  "strokes."  The  marvelous  part  of  it  is 
that  they  last  through  one.  It  is  a  high  tribute  to  Nature  that  she  has 
arranged  many  automatic  alarms  and  methods  of  protection,  and  it  is  a 
disgrace  to  the  medical  profession  that  it  has  not  only  never  studied  these 
automatic  arrangements  with  a  view  to  utilizing  them  in  a  natural  way, 
but  has  studied  how  to  suppress  pain  with  hypodermics,  how  to  "stimu- 
late" heart  action  with  digitalis,  nitro-glycerine,  etc.  When  an  Ophthal- 
mologist finds  persons  under  six  feet  high,  weighing  200  pounds,  or  more,  it 
is  his  duty  to  warn  them  that  they  are  sick,  and  that,  in  addition  to  eye 
corrections,  if  they  want  to  be  perfectly  well  and  happy,  they  should  take 
off  forty  pounds,  not  by  starvation,  but  by  cutting  out  sweets  and  starches. 
They  can  take  all  the  food  they  want  if  they  will  take  the  right  kind.  Right 
here  it  is  proper  to  refer  to  what  the  old  schools  say  about  "losing  flesh." 
They  say  that  to  take  off  more  than  twenty  pounds  a  month  is  dangerous. 
We  do  not  take  off  "flesh."  We  quit  feeding  the  stuff  that  makes  fat,  and 
Nature  throws  it  off  by  her  regular  processes,  all  the  while  making  flesh 
and  nerve  force.  As  to  the  amount  that  can  be  taken  off  without  harm,  we 
would  not  like  to  make  an  estimate.  Between  August  15th  and  September 
loth,  1902,  Dr.  T.  C.  Seright,  an  old  school  physician  of  Chatsworth,  111.,  went 
from  269  pounds  to  198,  a  loss  of  71  pounds  in  30  days.  He  certainly  lost 
fat  and  weight,  but  he  gained  flesh  and  nerve  force  to  such  an  extent  that 
instead  of  being  flabby,  he  was  as  solid  as  a  brick;  to  show  his  agility 
he  pulled  the  office  couch  to  the  middle  of  the  floor  and  took  a  standing 
jump  over  it.  He  never  missed  a  meal,  but  he  did  not  eat  the  carbonates,  he 
lived  on  nitrates  and  phosphates. 

Appendicitis  means,  literally,  inflammation  of  the  vermiform  appendix,  a 
worm-like  appendage  attached  to  the  caecum  posteriorly;  the  apparatus  is 
located  in  the  right  inguinal  region,  or  southwest  corner  of  the  body,  as 
you  face  it  like  a  map.  Drawing  an  obliq\ie  line  from  the  navel  to  the  an- 
terior superior  spine  of  the  ilium,  or  pelvic  bone  and  putting  the  finger 
in  'the  middle  of  that  line,  will  locate  the  point  where  pain  is  felt  in  so- 
called  appendicitis.  This  proves  what  we  have  always  contended,  and  what 
operators  confess,  viz. :  that  such  cases  rarely  exhibit  any  trouble  with  the 
appendix;  probably  not  more  than  one  in  one  hundred.  The  proper  name 
for  the  trouble  is  intussusception,  which  is  a  telescoping  of  the  ileum,  the 
last  section  of  the  small  intestine,  into  the  caecum  at  what  is  known  as  the 
ileo-csecal  valve.  The  reason  for  this  is  people  who  eat  wrongly  and  have  eye 
strain  are  nearly  always  constipated,  for  two  reasons ;  First,  there  may  be 
tonic  spasm  of  the  nervous  system  to  such  an  extent  that  it  grips  the 
sphincter  ani  so  tight  it  will  not  relax,  it  gets  into  a  cramp,  and  this  backs 
up  on  the  peristaltic  nerves  of  the  intestines,  and  sometimes  above  them, 
causing  strictures  of  the  esophagus,  or  the  nerve  supply  may  be  so  weak 
that  peristalsis  is  inactive,  that  is  static ;  the  second  reason  is  that  the  food, 
not  being  digested  properly,  forms  solid  masses  in  the  small  intestines, 
and  when,  eventually,  these  pass  into  the  caecum  they  carry  the  end  of  the 
bowel  with  them ;  then  a  stricture  ensues,  just  the  same  as  a  hernia,  and  it 
causes  intense  pain,  setting  up  inflammation  ;  but  it  is  more  liable  to  involve 


GENERAL  DISORDERS  CALLED  "DISEASES"  231 

the  peritoneum,  the  lining  membrane  of  the  abdomen,  than  the  appendix. 
Operation  may  have  occasionally  saved  a  life,  but  where  it  saved  one,  it 
killed  ten,  and  except  in  the  ones  it  killed,  the  possibilities  of  return  attack 
were  not  removed.  The  Mayos  operated  upon  former  Governor  Johnston 
of  Minnesota,  and  removed  his  appendix,  after  which  they  performed  three 
other  operations  for  "recurrent  appendicitis,"  according  to  the  despatches, 
and  finally  the  Governor  succumbed,  since  which  time  he  has  had  no  ap- 
pendicitis. At  the  same  time  one  of  our  Neurologists  in  Minnesota  treated 
ninety  cases  which  had  been  diagnosed  by  "regulars"  as  appendicitis,  and 
not  only  did  not  lose  One,  but  he  taught  his  patients  how  to  live  so  they 
would'  not  be  constipated ;  hence  there  was  no  further  possible  danger  of 
"appendicitis."  These,  of  course,  are  Neurological  cases. 

Asthma,  hay  fever,  and  similar  exhibits,  are  nearly  always  due  to  un- 
corrected  hyperopia,  and  wrong  living  in  the  matter  of  eating.  In  young 
people  the  correction  of  the  eyes,  with  baths,  and  food  restrictions,  often 
removes  enough  of  the  causes  so  that  the  exhibits  disappear  entirely  and 
permanently.  In  older  people,  where  the  complications  are  greater,  and 
habits  harder  to  break  up,  it  requires  Neurological  treatment,  which  means 
that  they  go  to  a  Neurological  Home,  and  take  a  regular  course  in  hygiene 
No  matter  what  they  pay  for  it,  they  get  value  received. 

Biliousness  is  a  form  of  indigestion  in  which  the  lymphatics  are  in- 
tensely involved.  The  old  schools  call  it  liver  trouble.  Sometimes  they 
give  it  the  name  jaundice,  and  some  people  know  it  as  "yellow  janders." 
The  tongue  is  usually  badly  coated,  and  the  patient  is  mentally  grouchy. 
If  the  liver  was  really  involved  to  the  extent  the  doctors  claim,  it  would  not 
be  doing  business ;  it  might  as  well  be  a  bunch  of  clay ;  and  if  the  liver  does 
get  involved  in  such  cases  it  is  pretty  dangerous,  because  of  the  liability 
to  the  formation  of  calculi  or  gall-stones.  These  are,  as  a  rule,  Neurological 
cases,  but  while  sending  them  to  a  Neurologist,  the  Ophthalmologist  should 
first  correct  the  errors  of  refraction,  suggest  hot  baths,  and  a  strict  fruit 
diet,  because  it  will  facilitate  the  Neurological  work  and  the  Ophthalmologist 
will  get  his  fee. 

A  Fetid  Breath  is  a  most  obnoxious  thing,  and  everyone  should  learn 
something  of  the  causes,  and  how  to  prevent  them.  First,  indigestion  of  a 
very  slight  amount  will  exhibit  in  the  breath  and  in  a  slight  coating  of  the 
tongue ;  its  odor  is  peculiar  and  less  offensive  than  any  other,  excepting  the 
normal ;  it  is,  however,  often  accompanied  by  nasal  or  faucial  catarrh,  and 
that  is  a  killing  combination.  Bad  teeth,  particularly  if  there  is  necrosis, 
gives  an  awful  breath.  Cigarettes  are  probably  the  worst  because  so  easily 
avoided.  Liquor  and  tobacco  are  offensive  to  most  people.  There  is  no 
reason  why  people  who  want  to  have  agreeable  breaths  cannot  do  so  by 
avoiding  the  causes,  and  when  going  out  into  company,  if  there  is  a  slight 
odor  to  the  breath,  a  little  pinch  of  common  salt,  so  much  as  a  cubic  centi- 
meter, washed  down  with  a  glass  of  water,  will  take  care  of  it  for  an  even- 
ing. The  remarkable  effect  of  sex  excitement  on  the  breath  will  be  discussed 
in  Vol.  II,  where  with  a  preliminary  knowledge  of  anatomy  and  physiology 
generally,  it  will  be  appreciated  more. 

Bunions,  corns,  ingrowing  nails,  etc.,   are  produced  by  ill-fitting  shoes. 


232  A  SYSTEM  OF  MATURE  MEDICINE 

more  than  by  shoes  which  are  too  tight.  A  bunion  is  a  dislocated  joint,  and 
in  treating  them  Neurologically,  we  not  only  set  the  joints,  but  we  throw 
away  the  patients'  shoes,  and  require  them  to  get  some  that  will  fit  and 
not  dislocate  the  toes  again.  As  to  ingrowing  nails,  anyone  can  fix  them 
by  taking  a  little  piece  of  broken  glass  and  scraping  the  nail  all  over,  but 
particularly  the  middle  third,  until  it  is  quite  thin,  then  raising  the  corners 
and  putting  pledgets  of  cotton  under.  Corns  should  be  sandpapered,  not 
cut.  There  are  some  corn  -preparations  by  which  the  callous  portion  is 
softened  and  peels  off,  but  after  that  the  part  should  be  kept  soft  with 
vaseline,  or  thuya  oil,  or  any  kind  of  oil,  and  the  shoes  should  be  fixed  so 
the  pressure  will  be  removed.  This  can  be  done  by  putting  a  small  pad  at  one 
side  of  the  corn  and  fastening  it  with  adhesive  plaster.  For  children,  the 
best  way  to  get  rid  of  corns  is  to  let  them  go  barefoot.  The  particular  rea- 
son these  things  are  mentioned  here  is  that  if  the  patient  comes  to  have 
his  or  her  eyes  fitted,  and  begins  to  wriggle  around  in  the  chair,  it  will  often 
be  found  corns  are  hurting  so  they  cannot  sit  still.  The  Ophthalmologist 
should  take  the  shoes  off,  work  out  the  toes  gently  for  a  few  minutes,  and 
after  the  patient  is  comfortable,  go  ahead  with  his  work.  He  might  as  well 
try  to  fit  a  patient  sitting  on  tacks  as  to  work  on  one  who  is  being  irritated 
in  any  way.  In  this  connection  he  must  be  careful  to  do  nothing  himself  by 
word  or  act  that  will  irritate  the  patient,  because  the  nervous  system  is  very 
sensitive,  and  is  liable  to  tonic  or  clonic  spasm  all  the  time. 

Calculi  are  hard  deposits ;  hence  are  called  stones,  and  when  they  form 
in  the  liver  they  are  called  biliary  calculi,  in  the  gall  bladder  they  are  called 
gall-stones.  In  the  kidneys  they  are  called  renal  calculi,  and  when  they  form 
in  the  bladder  they  are  called  vesical  calculi.  They  are  developments  from 
the  same  substances  which  obstruct  the  vessels  and  cause  abscesses,  fill  in 
connective  tissue  and  develop  muscular  rheumatism;  in  the  joints,  they  cause 
arthrictic  rheumatism,  with  the  only  difference  that  they  are  not  so  stony 
as  when  they  form  in  organs,  and  while  they  do  not  cause  as  much  pain  as 
the  stony  formations,  they  are  liable  to  chemical  reactions  in  Nature's  effort 
to  throw  them  off.  They  develop  toxemia  or  blood  poison,  exhibiting  as 
inflammatory  rheumatism,  erysipelas,  smallpox,  or  other  skin  diseases.  The 
Ophthalmologist  will  not  treat  such  cases,  but  is  liable  to  find  them  when 
patients  come  to  him  for  eye  troubles,  and  it  is  his  duty  to  send  them  to 
a  Neurologist. 

Catarrh  is  described  as  nasal,  faucial,  broncho-pulmonary,  gastro-in- 
testinal,  and  genito-urinary.  These  are  all  cases  that  Ophthalmologists  can 
instruct  in  connection  with  the  correction  of  eyes  so  that  they  will  get  much 
relief:  hot  baths,  strictly  fruit  diet,  snuffing  salt  water  three  times  daily — a 
half  a  pint  with  a  teaspoonful  of  salt  dissolved  in  it.  Of  course,  .when  any 
patient  of  any  class  measures  below  the  safety  line,  all  work  should  be 
suspended,  and  if  at  the  end  of  a  week  there  is  not  decided  improvement,  it 
is  a  Neurological  case. 

Chorea,  commonly  called  St.  Vitus's  dance,  is  a  nervous  trouble  in  which 
the  eyes  oscillate,  and  often  the  whole  head  shakes.  In  cases  of  children, 
the  Ophthalmologist,  with  his  glasses  and  advice  with  reference  to  baths, 
etc.,  can  often  do  for  $50  to  $100  what  a  Neurologist  would  have  to  charge 


GENERAL  DISORDERS  CALLED  "DISEASES"  233 

$300  to  $500  for,  and  as  there  is  no  immediate  danger,  we  recommend  that 
people  try  the  Ophthalmologist,  because  there  are  more  of  them,  and  they 
are  often  nearer,  thus  saving  expense.  He  will  always  do  good,  and  if 
he  does  not  accomplish  complete  results  it  is  because  of  complications  which 
can  be  reached  only  by  a  Neurologist,  and  these  are  not  frequently  present. 

Constipation.     See  remarks  on  Appendicitis. 

Debility  is  a  condition  of  exhaustion,  both  nervous  and  with  reference 
to  the  quality  and  quantity  of  blood.  It  may  be  of  congenital  origin,  and  in 
such  cases  the  child  grows  some,  and  may  even  become  quite  large,  but 
troubles  begin  to  exhibit,  such  as  loss  of  the  special  senses,  heart  weakness, 
various  children's  illnesses,  and  along  about  the  age  of  puberty  they  sometimes 
exhibit  atrophy  of  the  optic  nerves.  If  doctors  would  assist  in  educating  the 
public  so  that  parents  would  seek  aid  for  their  little  ones  early,  much,  if 
not  all,  of  the  troubles  might  be  aborted.  Other  children  are  born  well,  but 
become  debilitated  from  malnutrition;  this  may  be  from  lack  of  food;  it 
is  more  often  due  to  improper  food,  that  is,  foods  that  taste  well,  but  have 
little  actual  nourishing  qualities.  Others  are  born  well  but  are  vaccinated 
early  with  dire  results.  I  was  one  of  these,  and  did  not  conquer  the  effects 
of  the  crime  of  vaccination  for  thirty  years,  and  then  only  by  having  in  the 
meantime  discovered  that  coupled  with  the  infection  I  had  eye  strain  and 
had  been  living  ignorantly.  Another  class  is  born  all  right,  except  that  the 
eyes  are  deficient,  and  never  develop  up  to  normal;  hence  there  is  a  con- 
stant strain  on  the  nervous  system,  and  at  the  age  of  puberty,  when  sys- 
temic changes  take  place  involving  a  new  physiology,  particularly  in  girls, 
there  is  a  break-down,  and  they  frequently  die  from  what  has  been  known 
as  "hasty  consumption."  The  old  axiom  that  "an  ounce  of  prevention  is 
worth  a  pound  of  cure"  never  applied  more  forcibly  than  in  the  cases  of 
children  and  youth.  After  maturity  debility  comes  from  various  causes, 
physical  and  mental  weakness,  physiological  strain,  habits,  occupational 
demands,  and  exposure  to  atmospheric  influences ;  these  causes  are  sup- 
plemented by  neglect,  or  mal-treatment  with  drugs  and  operations,  yet  after 
all,  many  of  the  so-called  "incurables"  respond  readily  when  their  eyes  are 
corrected,  and  they  are  instructed  in  normal  habits  of  living.  The  debility  of 
old  age  is  natural,  because  the  machinery  is  wearing  out;  but  it  may  be 
held  off  for  a  long  time  by  those  over  sixty,  who  will  restrict  themselves  to 
the  nitrogenous  foods,  and  other  rational  measures. 

Diabetes  is  not  so  much  a  disease,  even  in  the  sense  of  the  word  as  it 
is  employed  by  old  school  doctors,  as  it  is  an  obstruction.  It  is  principally 
a  clogging  of  the  vascular  system  from  too  much  sweet  and  starchy  food, 
and  may  run  on  for  years,  the  individual  feeling  fairly  well,  but  never  per- 
fectly so.  Eventually,  however,  the  kidneys  become  so  thoroughly  clogged 
that  they  can  no  longer  perform  their  function,  when  it  does  not  take  long 
for  the  end  to  come,  and  it  is  usually  very  distressing.  There  are  two  kinds 
of  this  trouble,  one  is  called  diabetes  insipidus;  the  other  diabetes  mellitus. 
The  first  is  characterized  by  frequent  and  profuse  urination,  often  accom- 
panied by  abnormal  desires  for  water,  or  other  drinks,  and  if  everyone  could 
know  that  when  such  symptoms  exhibit,  all  sweets  and  starchy  foods  should 
be  cut  out,  and  fruit  juices  substituted,  particularly  large  quantities  of  lemon 


234  A  SYSTEM  OF  MATURE  MEDICINE 

juice,  considerable  salt,  plenty  of  hot  baths,  and,  if  possible,  an  entire  change 
of  atmospheric,  climatic  conditions  for  a  month,  to  be  followed  by  consistent 
living  thereafter,  much  trouble  could  be  avoided.  The  exhibits  of  the  second 
condition  are  difficult  urination,  highly  discolored  urine  and  much  sugar  in 
it.  This  is  decidedly  the  worse  of  the  two  conditions,  and  while  the  same 
treatment  works,  it  has  to  be  continued  longer.  In  this  connection  we  have 
made  an  interesting  discovery,  and  have  been  teaching  it  to  our  students 
for  many  years.  Physicians  who  have  taken  our  course  have  been  astonished 
at  the  results  they  get  by  following  our  suggestions.  They  reported  having 
had  many  cases  of  frequent  desire  to  urinate,  but  the  passing  of  small  quan- 
tities at  each  effort.'  Not  having  felt  it  proper  to  depart  from  the  custom 
of  following  the  lead  of  their  teachers,  they  called  the  exhibit  polyuria, 
which  is  the  usual  condition  in  diabetes,  but  analysis  of  the  urine  failed 
to  yield  chemical  proof  of  their  diagnosis ;  they  kept  on  treating  it  as  dia- 
betes, however,  and  when  they  came  to  us  many  of  them  reported  having 
been  treating  cases  from  six  months  to  two  years  without  results.  When 
we  told  them  it  was  not  a  case  of  polyuria,  but  was  poly-want-to-uria,  be- 
cause true  polyuria  is  not  only  frequent  desire  but  abundant  passage  of 
urine,  they  took  it  as  a  joke,  until  we  explained  that  the  tonic  spasm  at  the 
mouth  of  the  bladder,  incited  by  the  nervous  effort  to  overcome  hyperopia, 
was  the  cause  of  the  trouble,  and  the  correction  of  the  hyperopia,  'and  con- 
sequent relaxation  of  the  nervous  cramp,  would  relieve  the  causes  permanent- 
ly in  short  order.  They  went  home,  and  sent  for  their  cases,  fixed  their  eyes, 
and  put  them  on  baths  and  diet,  when  every  case  recovered  in  a  few  weeks. 

Dysmenorrhea,  painful  menstruation,  is  always  unnecessary,  and  is  al- 
ways due  largely  to  uncorrected  hyperopia,  the  irritating  cause,  which  stirs 
the  nervous  system  to  extraordinary  efforts  to  overcome  the  error,  with 
the  result  that  the  nerves  of  the  os  uterus  become  involved,  together  with 
all  other  sphincter  nerves  in  the  body;  and  a  secondary  cause  is  that  when 
the  regular  monthly  period  comes  around,  there  is  a  local  irritation,  which 
adds  to  the  nervous  demand,  until  patients  sometimes  go  into  convulsions, 
after  which  relaxation  automatically  follows,  and  the  menstrual  flow  begins. 
The  great  danger  is  that  repetitions  coming  as  frequently  as  they  do,  in- 
crease the  liability  to  metritis,  inflammation  of  the  womb,  salpingitis,  in- 
flammation of  the  Fallopian  tubes,  and  ovaritis,  inflammation  of  the  ovaries, 
even  to  the  development  of  cystic  or  fibroid  tumors.  The  old-school  doctors 
have  treated  dysmenorrhea  .with  very  little  benefit,  and  that  only  temporary ; 
they  often  cause  patients  to  develop  the  morphine  habit ;  they  curette  and 
tampon  time  and  again,  all  because  they  do  not  know  the  anatomy  and 
physiology  of  the  body  as  they  should  know  it,  and  knew  nothing  of  physical 
or  physiological  optics.  Our  Opthalmologists  have  no  trouble  in  handling 
such  cases,  and  always  get  permanent  results. 

Dyspepsia,  a  chronic  form  of  indigestion,  physiological  and  mental,  is 
often  mistaken  by  its  victims  for  religion,  in  fact  nearly  all  religion  is  in- 
digestion, as  we  have  proved  many  hundreds  of  times  by  establishing  nor- 
mal physiological  action  throughout  the  body,  when  the  exhibits  of  bigotry, 
fanaticism,  superstition,  and  credulity,  the  four  principal  elements  of  re- 
ligion, passed  away  entirely.  It  is  simply  the  same  old  story  of  hyperopia 


GENERAL  DISORDERS  CALLED  "DISEASES"  235 

and  dissipation.  Our  "reformer"  friends  regard  dissipation  as  the  indul- 
gence by  others  of  habits  and  inclinations  of  which  they  do  not  approve, 
such  as  drinking  liquors,  attending  theaters,  baseball  games,  horse  races,  and 
other  forms  of  entertainment.  We  do  not  mean  such  things  exclusively 
when  we  use  the  word.  We  assert  that  dissipation  is  indulgence  in  any  ex- 
cess, whether  it  be  approved  by  fanatics  or  not.  This  recalls  an  experience  I 
once  had,  as  a  young  man,  wdth  a  reformer  who  was  so  intimate  with  our 
family  that  he  felt  it  his  privilege  to  correct  me.  One  New  Year's  day  I  had 
been  celebrating  with  a  lot  of  friends,  making  New  Year's  calls,  which  was 
the  correct  thing  in  those  days.  Some  of  the  young  ladies  had  served  wine, 
and  we  were  feeling  extra  good ;  we  had  eight  horses  hitched  to  a  big  sled, 
having  arranged  for  a  night  party  to  another  town ;  something  got  wrong 
with  one  of  the  horses  feet,  and  we  stopped  at  the  reformer's  blacksmith 
shop  for  an  examination.  Uncle  Bill  paid  little  attention  to  the  horse,  but  a 
good  deal  to  me ;  he  gave  me  a  lecture  on  temperance,  telling  me  in  most 
vigorous  language  what  a  villain  I  was;  a  disgrace  to  my  family.  I  was 
feeling  very  good-natured,  and  I  beamed  on  him  most  interestedly  until 
he  finished ;  then  I  said :  "Uncle  Bill,  I  am  pretty  full ;  but  I  am  not  running 
over,  and  you  are."  Tobacco  juice  was  running  out  of  his  mouth,  and  on  his 
shirt  bosom,  while  he  talked.  Intemperance  is  dissipation,  no  matter  wheth- 
er it  be  in  eating,  drinking,  talking,  or  going  to  excess  in  any  other  manner. 
Neurology  teaches  us  that  there  are  natural  results  from  all  such  excess, 
that  it  is  neither  penalty  nor  reward,  and  that  if  we  would  avoid  unpleasant 
consequences,  we  must  first  avoid  those  things  which  cause  them.  Some  of 
these  things  can  be  taught  people  by  books,  or  by  word  of  mouth,  others 
must  be  put  in  practice  by  us  on  our  patients,  after  we  qualify  ourselves  for 
the  work.  There  are  difficulties  attending  this,  because,  having  been  edu- 
cated wrongly,  many  people  think  they  know  more  about  what  is  good  for 
them  than  we  do.  I  have  been  told  by  patients  that  they  believed  they  knew 
as  much  about  their  own  stomachs  as  anybody  did,  and  certainly  ought  to 
know  something  about  food  because  they  had  been  eating  it  for  many  years. 
I  have  told  such  people  I  would  wager  ten  dollars  they  did  not  know  where 
their  stomachs  were.  They  declared  they  did,  and  indicated  its  position 
by  placing  a  hand  low  down  on  their  bellies.  I  told  them  what  they  needed 
was  an  operation,  possibly  two  of  them,  one  to  put  the  stomach  back  where 
it  belongs  naturally,  and  the  other  to  find  what  was  the  matter  with  their 
brains.  I  dismiss  all  such  cases  with  the  information  that  they  are  not 
worth  fixing. 

Earache,  or  otitis,  is  qur.te  common  in  children,  and  its  cause  is  usually 
a  drying  and  hardening  of  the  cerumen,  or  ear  wax,  the  primary  cause  be- 
ing uncorrected  hyperopia,  which  causes  such  a  drain  on  and  irritation  of 
the  nervous  system  that  there  is  not  only  a  general  weakening  of  producing 
power  in  all  directions,  but  there  is  an  overheating  of  all  tissues,  which 
tends  to  dryness.  Hot  baths,  or  hot  water  put  in  the  ears,  and  allowed  to 
run  in  as  far  as  it  will,  is  the  proper  treatment  locally,  and  it  should  be  fol- 
lowed by  warm  sweet  oil.  There  is  practically  no  other  cause  for  this  trouole 
than  the  two  named.  In  old  people  they  do  not  have  so  much  earache, 
although  they  might  have  a  facial  neuralgia  from  hardened  wax ;  but  they  do 


236  A  SYSTEM  OF  MATURE  MEDICINE 

often  exhibit  tinitis  aurium,  a  ringing  in  the  ears,  and  they  will  tolerate  it 
for  years  before  they  do  anything  for  it ;  then,  of  course,  it  is  a  much  bigger 
job,  but  it  is  surprising  how  quickly  we  get  results  even  for  them,  using  the 
same  treatment  as  for  children. 

Eczema,  and  other  skin  disease  exhibits,  are  all  due  to  wrong  living 
and  uncorrected  hyperopia.  Of  course,  the  public  has  been  taught  that  dis- 
eases are  the  products  of  witchery  and  bugs,  and  they  incline  to  look  upon  all 
common-sense  explanations  as  humbug.  It  is  hard  to  induce  people  to 
try  the  experiment  of  living  decently ;  unless  they  become  acutely  ill  they  are 
absolutely  indifferent  to  their  appearance,  no  matter  how  disgraceful  it  may 
be  in  the  eyes  of  those  who  know  how  to  live  and  do  live.  There  is  one 
weapon  everyone  of  them  fears  more  than  any  other,  and  that  is  ridicule. 
Therefore,  we  have  no  hesitancy  in  pointing  out  the  shamefulness  of  catarrh, 
skin  exhibits,  and  other  symptoms  of  foolish  living,  and  we  declare  they  are 
as  discreditable  to  each  individual  as  it  would  be  to  have  it  known  they  were 
lousy.  It  makes  no  difference  what  protests  they  offer,  the  facts  remain 
facts  just  the  same.  There  are  mitigating  circumstances  which  all  must 
admit.  For  example,  we  have  had  many  cases  of  young,  ignorant  women 
whose  faces  were  so  pimply  they  wore  double  veils  in  public,  because  they 
felt  a  humiliation  over  their  appearance ;  but  these  always  made  good  pa- 
tients, being  eager  to  learn  what  to  do  to  get  rid  of  the  exhibits,  and  we  made 
everlasting  friends  of  them  in  sixty  days.  As  a  rule,  this  work  is  within  the 
scope  of  the  Ophthalmologist,  but  sometimes  they  are  Neurological,  and  our 
Ophthalmologists  learn  while  in  school  exactly  what  their  limitations  are 
until  they  shall  have  completed  Neurology. 

Epilepsy,  meaning  "to  leap  upon,"  is  one  of  the  evidences  we  offer 
to  prove  the  superstition  of  the  old  school  doctors  who  named  diseases. 
They  believed  that  the  devil  lurks  around  in  nooks  and  corners  in  the  form 
of  microbes  and  bacteria  of  all  sorts,  and  leaps  on  individuals  as  they  go 
by.  They  have  used  bromides  and  iodides  of  sodium  and  potassium,  until 
they  destroyed  mentalities  in  their  vain  efforts  to  "cure"  this  trouble,  when, 
about  all  that  is  needed  in  the  average  case  of  a  child  is  to  correct  its  hyper- 
opia, and  its  habits  of  diet,  give  it  plenty  of  hot  water  to  bathe  in,  caution 
it  against  permitting  its  temper  to  run  wild,  relieving  it  of  fear  by  teaching 
it  that  it  is  within  its  power  to  prevent  the  seizures.  Of  course,  some  chil- 
dren are  congenitally  defective,  or  debilitated,  and  the  cases  are  more  com- 
plicated. Again,  when  the  condition  has  been  allowed  to  run  along  until  the 
individual  is  grown>  or  if  the  fits  do  not  exhibit  until  maturity,  the  situation 
is  harder  to  handle.  Practically  all  of  these  cases  are  Neurological  ones, 
but  as  Ophthalmology  involves  much  of  the  mechanical  part  of  Neurology, 
no  harm  can  come  from  what  Ophthalmologists  do,  and  they  may  save 
parents  a  large  part  of  the  expense  in  treating  children,  who,  as  a  rule, 
yield  more  readily  than  older  patients. 

Habits.  These  range  from  the  talk  habit  to  the  cocaine  habit,  and  cover 
a  multitude  of  mental  and  physiological  misdemeanors.  We  regret  to  say 
tHat  the  chief  causes  are :  First,  general  ignorance,  even  among  so-called 
educated  people.  Second,  the  practice  of  drug  doctors  who  give  medicines 
which  develop  drug  habits  insidiously.  Third,  a  general  indifference  to 


GENERAL  DISORDERS  CM  LED  "DISEASES"  237 

the  study  of  those  things,  to  do  which  and  secure  permanent  health  would 
require  the  practice  of  a  reasonable  amount  of  self-denial.  Fourth,  and 
last  but  not  least,  uncorrected  hyperopia,  which  is  the  primary  cause  of  85  per 
cent,  of  all  human  ills,  by  reason  of  the  fact  that  it  institutes  an  extraordinary 
nervous  demand  for  accommodation,  which  first  irritates  and  then  weakens. 
Among  the  symptoms  of  irritation  are  uncontrolled  desires  for  something, 
the  individual  does  not  know  what,  but  he  automatically  turns  to  stimulants, 
liquor,  tobacco,  drugs,  social  excitement,  religion,  politics,  adventure,  even 
to  committing  crime.  It  is  the  province  of  Neurology  to  call  attention  to 
these  things  in  language  that  even  children  can  understand,  and  we  teach  our 
students  to  advertise  in  what  we  regard  as  a  legitimate  manner,  not  vaunting 
themselves,  but  by  giving  people  information.  This  naturally  introduces 
them  to  the  public,  and  if  any  readers  find  they  have  conditions  which  they 
are  unable  to  control,  they  naturally  consult  one  in  whom  they  have  con- 
fidence. In  writing  these  circulars  of  information,  our  doctors  educate  them- 
selves, as  well  as  the  public,  just  as  we  educate  ourselves  in  teaching  our 
students. 

Heart  Disease.  See  Angina  Pectoris.  In  this  connection  it  is  proper 
that  the  reader  should  have  some  information.  The  heart  is  a  big  muscle, 
comprising  four  compartments,  the  two  upper  ones  are  called  auricles  and 
the  lower  ones  ventricles.  Into  the  right  auricle  flows  the  blood  from  all 
over  the  body,  through  the  superior  and  inferior  venae  cavse.  From  there 
it  passes  through  the  tricuspid  (three-leaf)  valve  into  the  right  ventricle; 
then  it  passes  through  a  series  of  semi-lunar  (half-moon)  valves  into  the 
pulmonary  artery,  which  distributes  it  throughout  the  lungs,  where  carbon- 
dioxide  is  discharged  and  oxygen  taken  on ;  next  it  is  delivered  by  way  of 
the  pulmonary  veins,  as  arterial  blood,  into  the  left  auricle,  from  which  it 
passes  into  the  left  ventricle  through  the  bicuspid  (two-leaf)  or  mitral- 
valve  ;  thence  by  way  of  a  series  of  semi-lunar  valves  into  the  aorta,  which 
passes  up  over  the  left  lung  and  down  behind  it,  giving  off  branches  as  it 
goes  and  finally  after  passing  through  the  diaphragm  close  to  the  spinal 
column,  it  bifurcates  into  the  two  common  iliac  arteries,  and  each  of  these 
fork  again  into  the  internal  and  external  iliacs,  the  first  supplying  the 
abdominal  viscera,  and  the  second  going  largely  to  the  legs.  The  heart  oper- 
ates by  two  motions,  systole  and  diastole.  It  is  a  sort  of  combined  pumping 
and  syphoning  process,  the  contraction  being  first  at  one  end  and  then  at 
the  other.  When  the  dilation  is  at  the  lower  end,  the  contraction  is  above, 
thus  the  ventricles  fill ;  then  as  the  contraction  below  takes  place,  it  pumps 
the  blood  to  the  lungs  and  to  the  aorta,  while  the  dilation  of  the  auricles 
causes  suction,  which  draws  the  blood  from  the  venous  system  and  from 
the  lungs.  This  action  alternates  like  the  beats  of  a  clock,  and  should  be  as 
regular,  running  70  to  the  minute  in  adults,  normally.  When  it  runs  too 
fiast  or  too  slow,  or  misses  beats,  it  is  not  the  fault  of  the  heart,  but  of  ir- 
ritation or  weakness  of  the  nervous  system.  If  the  valves  leak,  it  is  not 
"valvular  disease,"  but  is  simply  due  to  enervation,  which  is  deficient  in- 
nervation.  Our  Ophthalmologists  have  corrected  more  of  this  trouble  than 
all  the  old  school  doctors  ever  will.  When  the  old  schools  win  a  case,  it  is 
purely  accidental. 


238  A  SYSTEM  OF  MATURE  MEDICINE 

Headache  is  also  called  migraine.  Sometimes  this  exhibits  merely  a 
dull,  continuous  ache.  Sometimes  it  takes  the  shooting-pain  form  and  is 
called  neuralgia.  The  very  fact  that  the  old  schools  have  given  coal  tar 
products,  morphine  and  other  drugs  to  suspend  the  sensation  of  feeling,  and 
called  it  a  headache  "cure"  is  sufficient  proof  of  incompetence  to  warrant 
the  passage  of  laws  forbiding  the  employment  of  drugs.  From  the  Harri- 
son anti-narcotic  law  much  benefit  has  resulted,  and  more  will  result,  be- 
cause when  people  wake  up  to  the  fact  that  cocaine  and  morphine  users  are 
not  the  only  victims  of  the  drug  habit,  but  that  women  and  children  by  the 
thousand  are  being  doped  for  headaches,  that  will  be  stopped,  and  the 
causes  of  the  aches  and  pains  will  be  remedied.  The  doctors  will  have  to 
learn  Neurology,  or  go  out  of  business,  whether  they  learn  it  from  us,  or 
from  our  books,  or  from  the  sheer  force  of  necessity,  because  they  will  not 
be  allowed  to  maltreat  patients  any  more.  It  has  to  come.  Pain  and 
fever  are  Nature's  two  most  conspicuous  beneficent  provisions  against  dis- 
order, because  they  automatically  warn  us  when  anything  goes  wrong.  It 
is  a  shame  that  the  old  schools  of  medicine,  instead  of  teaching  how  to 
utilize  these  things  to  locate  causes  and  remove  them,  have  taught  the 
use  of  the  hypodermic  syringe  and  internal  medication  to  suppress  those 
exhibits.  When  a  burglar  proposes  to  rob  a  bank,  he  cuts  the  telephone 
wires  runing  from  the  bank  to  the  detective  agency.  We  never  hear  of  the 
fire  department  cutting  its  own  wires,  or  of  the  detective  department  cutting 
wires.  It  is  only  "scientific  medical"  men  who  commit  such  foolishness. 

Hypochondria  is  a  state  of  melancholy  into  which  certain  classes  of 
cases  fall  from  long  continued  disorder,  and  while,  as  a  rule,  these  are  all 
Neurological  cases,  the  Opthalmologist  may  do  an  enormous  amount  of 
good  by  correcting  the  hyperopia,  and  giving  instructions  how  to  take  baths 
and  exercises.  Of  course,  in  considering  hyperopia  as  a  cause  of  nervous 
disturbances,  it  must  always  be  remembered  that  the  greater  the  amount  of 
hyperopia,  the  greater  its  potency  as  an  exhaustive  feature,  and  the  less 
the  amount  of  hyperopia,  the  less  potency  there  is ;  but  when  we  remember 
that  one  unit  of  hyperopia  causes  23  per  cent,  increase  in  the  daily  nerve 
demand,  and  every  additional  unit  adds  23  more  per  cent.,  its  potency  as  a 
trouble  causer  may  be  appreciated. 

Hysteria  is  the  opposite  condition  to  the  one  named  above,  and  this 
class  of  cases,  while  making  much  more  ado  than  the  other,  is  many  times 
easier  to  handle,  so  far  as  physiological  control  is  concerned.  Occasionally, 
when  the  melancholy  ones  have  not  lost  their  mentalities  to  a  large  extent, 
so  that  they  have  no  ambition  to  get  well,  they  are  easiest  to  handle.  The 
hysteric  must  be  handled  gently  but  very  firmly,  and,  as  a  rule,  when  they 
are  impressed  with  the  fact  that  our  analysis  is  not  a  diagnosis;  that  there 
is  no  guess-work  or  opinion  by  us;  that  it  is  a  message  direct  from  Nature 
through  their  own  nervous  systems,  interpreted  by  us  after  being  care- 
fully trained  for  it;  that  it  is  law  which  must  be  obeyed;  that  in  order  to 
insure  Nature  will  not  be  tricked  we  require  them  to  pay  a  good  fee  in  ad- 
vance as  a  guarantee  they  will  obey  the  law,  we  win  all  the  time. 

Insomnia,  sleeplessness,  is  one  of  the  frequent  symptoms  of  nervous 
irritation  caused  by  excess  demands,  and  it  is  often  accompanied  by  a  resort 


GENERAL  DISORDERS  CALLED  "DISEASES"  239 

to  coffee,  tea,  liquor  and  other  stimulants,  for  which  we  substitute  lemon, 
pineapple,  and  other  fruit  juices,  while  readjusting  the  nervous  system, 
after  correcting  the  hyperopia ;  we  also  direct  the  taking  of  hot  baths  just 
before  retiring,  or  sometimes  a  walk  in  the  cool  night  air,  so  that  the  re- 
action upon  returning  to  a  warm  room  induces  sleep. 

Leucorrhoea  is  not  what  it  has  always  been  considered  by  the  phy- 
sicians. It  is  simply  a  local  exhibit  in  the  vagina,  produced  in  much  the 
same  manner  that  a  coating  of  the  tongue  is  produced ;  and  the  coated  tongue 
will  always  be  found  in  such  cases.  It  is.  simply  a  stage  of  debility,  and  it 
may  be  present  in  several  stages,  that  is,  it  may  be  the  only  symptom, 
or  it  may  be  present  and  there  be  also  prolapsus  uteri,  a  falling  of  the 
womb.  The  only  treatment  that  can  possibly  do  any  good  is  to  get  the 
system  built  up  nervously,  and  the  process  of  doing  that  develops  good 
blood,  good  bone,  good  muscle,  and  a  good  brain.  Many  of  these  cases  are 
purely  Ophthalmological,  because  they  are  associated  with  hyperopia,  which 
is  the  chief  causative  factor.  The  patient  can  give  herself  the  local  treat- 
ments, which  consist  of  baths  and  injections  of  strong,  warm  salt  water, 
twice  daily,  after  which  rest  should  follow.  One  of  the  douches  may.be 
taken  at  one  or  two  o'clock,  and  the  other  at  bedtime. 

Menorrhagia  is  another  menstrual  exhibit,  meaning  too  much  flow. 
There  may  be  dysmenorrhea  at  the  beginning,  followed  by  excess  flow,  or 
the  flow  may  be  too  frequent  and  too  long-continued  without  pain.  All 
such  cases  are  dangerous,  and  if  the  Ophthalmological  routine  does  not  give 
marked  results  in  a  month,  which  it  often  does,  the  case  should  be  sent  to 
a  Neurologist. 

Morning  sickness  is  a  very  common  exhibit  by  pregnant  women,  but 
it  is  often  exhibited  by  other  people,  particularly  girls,  between  14  and  20, 
whose  nervous  conditions  are  below  normal.  Some  of  them  have  developed 
ovarian  or  abdominal  tumors,  and  gossipy  neighbors  have  caused  their 
humiliation,  even  disgrace,  by  charging  them  with  "immorality."  If  there 
is  any  such  a  thing  as  ''immorality,"  I  would  apply  it  most  strenuously,  and 
as  the  rankest  exhibit,  to  those  whose  slanderous  tongues  are  always  ex- 
pressing opinions  about  matters  which  are  none  of  their  business,  and  of 
which  they  know  nothing.  According  to  their  own  estimate  of  the  word, 
it  fits  them  perfectly.  Ophthalmologists  can  take  nearly  all  of  these  cases, 
and  by  the  usual  correction  and  suggestions  bring  perfect  relief  quickly. 

Pneumonia.  This  is  not  caused  by  hyperopia,  although  a  person  whose 
system  is  already  weakened  by  the  strain  from  that  error  is  less  liable  to 
resist  the  atmospheric  and  other  conditions  which  produce  pneumonia.  The 
reports  show  that  about  15  per  cent,  of  the  drug  doctors  who  die,  the  causes 
of  whose  deaths  are  given,  are  taken  by  pneumonia.  This  is  absolutely 
disgraceful.  Anybody  and  everybody  ought  to  know  how  to  take  care  of 
pneumonia.  Hence  this  paragraph  :  At  the  first  indication  of  sore  throat,  or 
congestion  of  the  lungs,  the  victim  should  get  into,  or  be  put  into,  a  hot 
bath,  and  the  heat  increased  until  profuse  sweating  results,  then  dry  quickly, 
and  put  to  bed  ;  take  a  good  sized  bath  towel,  and  soak  it  with  cold,  salt 
water,  wring  it  out  a  little,  and  lay  it  on  the  chest  and  neck  from  the 
breasts  to  the  head.  The  objects  are,  first,  the  heat  relaxes  the  nervous 


240  A  SYSTEM  OF  MATURE  MEDICINE 

tension,  reduces  the  fever  to  practically  normal  in  fifteen  minutes,  and 
dilates  the  caliber  of  the  trunk-line  blood  vessels.  Second,  the  cold  ap- 
plication to  the  lungs  causes  a  contraction  of  the  vessels,  stimulates  the 
nerves  locally,  and  relieves  the  lungs  from  congestion.  If,  after  an  hour  or 
so  the  fever  comes  up  again,  and  there  is  further  congestion,  we  know  the 
dose  was  not  strong  enough,  so  we  give  another  one,  and  keep  it  up  as  often 
as  is  necessary  to  conquer.  Usually  three  or  four  baths  are  sufficient;  often 
one.  No  doctor  is  needed,  but  if  one  is  called,  he  should  at  least  have  com- 
mon sense  enough  to  know  what  to  do.  In  the  way  of  medication  all  we 
give  to  such  cases  is  all  the  fruit  juices  they  want  to  drink,  lemon,  orange, 
grape  fruit,  pineapple,  mixed  or  separate,  and  patients  should  be  kept  in 
the  house  for  several  days  until  the  system  is  restored  to  normal,  and  has 
had  a  rest. 

The  system  of  practice  which  we  call  "Mature  Medicine,"  and  of  which 
this  volume  is  the  mechanical  section  largely,  is  based  upon  mathematics, 
used  in  as  simple  forms  as  possible,  and  with  all  the  common  sense  at  our 
command. 


CHAPTER  XXIX. 
Human  Ills  and  Their  Causes  Viewed  From  a  Rational  Standpoint. 

All  of  the  Ills  of  Humanity  are  due  to  Nerve  Shock  or  Nerve  Strain, 
taking  the  proposition  as  a  fundamental  one.  The  following  diagrams  are  to 
aid  students  in  comprehending-  the  Duality  System  of  Analysis: 


Causes 


(Congenital  

Deficiency 

Chemical  

Debility 

Body 

Infection.  . 

Idiopathic 

{Systemic                  » 

Inoculation 
Internal 

Mechanical.  .  .  . 

Organic  

External 
Sensory 

Ills    .  . 

(Emotional  

Motor 
Hysteria 

Real  ,  

Melancholy 

Accidental  

Shock 

Mental   

Strain 

(Education  

Benign 

1 

False  

Malignant 

I 

Environment  
(Mental  , 

Positive 
Negative 

Shock 

(  Congenital  

Physical  

Strain 
Malnutrition 

{Voluntary.  . 

Infection 
Habitual 

1    Acquired  

Occupational 

T                      1 

Atmosoheric 

r  Skeletal  

Accidental 
Fractures 

Anatomical.... 

[  Muscular  

Dislocations 
Cuts 

(Systemic  

Sprains 
Nervous 

Physiological.  . 

Organic  < 

Vascular 
Real 

Imaginary 

For  many  years  I  have  asserted  that  there  are  ten  Possible  Causes  of 
Human  Ills,  all  of  which  are  subdivisions  of  the  Duality  mentioned  above. 
Of  course  there  are  innumerable  possible  combinations  of  these  causes; 
but  all  involve  the  original  Duality;  hence  my  claim  that  all  Ills  are  Nervous 
Ills,  and  my  differentiation  of  our  methods  as  Neurology,  a  System  of  Ma- 
ture Medicine.  I  would  not  be  understood  as  making  any  claims  to  absolute 
perfection.  This  is  impossible  for  two  reasons :  First,  Nature,  alone,  is 
infallible.  Second,  a  mature  individual  is  always  capable  of  adding  to  his 
store  of  information  and  it  follows,  naturally,  that  Systems  of  Practice  may 
be  Mature,  yet  be  susceptible  of  Improvements.  It  is  with  the  hope  of 


242  A  SYSTEM  OF  MATURE  MEDICINE 

stimulating  investigation   and  aiding  in   the  advancement  of  Natural    Laws 
as  the  most  promising  study,  that  this  book  and  the  one  to  follow  are  pub- 
lished. 
The  Ten  Causes  are: 

1.  Congenital,  due  to  conditions  pre-natal. 

2.  Infection,  at  the  moment  of  birth  or  any  time  thereafter. 

3.  Malnutrition,  from  lack  of  food  or  from  improper  food. 

4.  Physical  Shock,  by  accident  or  design. 

5.  Mental  Shock,  such  as  fright  or  appalling  news. 

6.  Physiological  Strain,  as  from  hyperopia  or  over-eating,  etc. 

7.  Mental  Strain,  as  suspense,  anguish,  anger,  etc. 

8.  Habits,  drug,  liquor,  or  dissipation  of  any  kind. 

9.  Occupation,  involving  worry,  hazard,  etc. 

10.  Atmospheric  Influences,  exposure,  climatic  and  otherwise. 

The  following  paragraphs  refer  particularly  to  the  diagrams  on  the 
preceding  page.  There  are  sixty-three  of  them,  one  for  each  subject  in  the 
diagrams ;  each  is  for  the  purpose  of  illustrating  the  application  of  the 
word  as  it  appears  in  these  arrangements,  not  necessarily  the  literal  mean- 
ings of  the  words,  nor  what  they  might  mean  in  other  diagrams.  It  will 
even  be  noted  that  when  the  same  words  are  used  in  different  columns  they 
have  different  significance : 

The  ills  of  humanity  have  been  due,  in  all  ages,  largely  to  ignorance. 
As  far  back  as  history  goes,  there  is  evidence  that  there  were  a  few  people 
who  sought  to  educate  their  fellowmen,  not  only  with  reference  to  the  hum- 
buggery  of  spiritual  fads  but  also  to  those  of  all  medical  fads.  Even  the 
two  factions,  medical  and  religious,  fought  among  themselves.  The  spiritual 
faddists  who  wrote  the  bible  made  frequent  references  in  disparagement  of 
the  medical  profession.  In  one  place  it  says :  "King  Asa  fell  sick  and 
called  not  upon  God,  but  upon  the  Doctors ;  and  Asa  slept  with  his  fathers." 
A  great  many  years  ago  an  eminent  student  asserted :  "Where  you  find  a 
dozen  doctors  in  company,  eleven  of  them  will  be  atheists."  The  average 
physician  of  today,  old-school,  is  a  member  of  some  church  organization, 
for  business  or  social  reasons ;  many  of  them  have  so  stated  to  me  per- 
sonally. There  is  scarcely  one  of  them  who  does  not  ridicule  Christian 
Science  and  all  other  "faith  cures ;"  yet  every  one  of  them  exhibits  the  most 
stupendous  faith  in  the  "curative"  qualities  of  drugs.  We  Neurologists  do 
not  believe  any  of  the  nonsense  about  "cures,"  whether  they  be  faith  or 
drug.  We  know  that  after  we  have  analyzed  a  case,  and  found  it  within 
range  of  recovery,  if  the  patient  follows  our  instructions,  faith  or  no  faith, 
there  will  be  recovery.  Hence  we  not  only  believe,  but  we  believe  because 
we  know  that  the  processes  of  Nature  all  tend  toward  good. 

The  body  includes  a  head,  trunk  and  appendages.  The  head  and  trunk 
contain  organs  more  or  less  developed,  and  this  development  is  altogether 
dependent  upon  how  the  apparatus  is  cared  for  in  the  matters  of  supplying 
nutrition,  seeing  that  waste  is  properly  discharged,  that  there  is  sufficient 
exercise  to  promote  development  where  it  is  most  needed,  and  that  excesses 
are  not  indulged  in. 

To  take  care  of  this  matter,  each  individual  is  provided  with  a  Men- 


HUMAN   ILLS  AND  THEIR  CAUSES  243 

tality,  which  is  something  we  all  know  exists,  although  it  has  never  been 
located  in  the  process  of  dissection.  In  it  we  have  evidence  corroborative 
of  a  proposition  we  have  often  made,  that  a  truth  is  anything  which  can  be 
demonstrated  physically  or  physiologically.  We  know  anatomy  is  truth 
because  we  can  demonstrate  it  physically.  We  know  mentalities  are  a  fact 
because  they  are  demonstrated  physiologically.  The  thing  itself  might  be 
called  by  any  other  name,  but  it  would  still  be  true.  Animals,  for  instance, 
have  mentalities,  not  as  highly  developed  as  the  human  race,  but  there  is 
no  question  about  their  capacity  to  think ;  I  have  seen  animals  perpetrate 
jokes  deliberately  and  laugh  about  it ;  I  have  seen  a  live  dog  tackle  an  iron 
dog  in  a  yard,  and  when  I  laughed  at  him,  he  actually  blushed ;  he  was  a 
white,  tramp  dog;  we  became  warm  friends  and  were  on  familiar  terms  for 
months.  These  mentalities  are  representatives  of  Infinity,  residing  with 
us  during  life.  What  Infinity  is,  we  do  not  know,  except  as  its  laws  are 
demonstrated  to  us  physiologically  by  the  movements  of  planets,  the  de- 
velopment of  vegetable  and  animal  life,  and  regular  seasons,  and  the  eventual 
evolution  of  all  life  back  to  its  elemental  state.  The  various  theories  de- 
veloped through  imaginations  of  these  mentalities  are  not  provable  either 
physiologically  or  physically,  so  long  as  they  refer  to  the  possibility  of  a. 
future  life,  reward,  punishment,  etc.  This  we  know  as  well  as  we  know 
anything,  and  we  know  that  we  or  anyone  else  would  be  wasting  time  trying 
to  effect  a  compromise  with  imaginary  gods,  or  devils.  We  have  evidence 
that  such  theories  are  very  dangerous  in  the  effects  they  exhibit  through 
many  mentalities.  The  insane  asylums  are  full  of  religious  fanatics  who 
became  dangerous  to  themselves  and  others.  The  morning  this  is  written 
we  have  an  account  of  a  religious  fanatic  who  murdered  five  people  before 
he  was  killed  by  the  police.  It  is  a  curious  thing  about  these  fanatical 
minds  that  they  are  apparently  absolutely  devoid  of  analytical  capacity. 
For  example,  they  write  in  the  bible  that  the  devil  took  Jesus  Christ  up  on  a 
hill  and  pointed  out  the  beautiful  landscape  to  him,  offering  it  all  if  he 
would  become  a  devil,  and  the  readers  point  with  pride  to  the  reply  of 
Jesus,  who  said,  "Get  thee  behind  me,  Satan."  Yet  all  through  that  bible  we 
find  bribe  after  bribe  offered  "to  those  who  love  me  and  keep  my  command- 
ments," and  threat  after  threat  to  those  who  disobey.  To  a  rational  mind 
all  bribes  appear  much  alike.  The  devil  did  not  do  any  threatening,  and  of 
the  two  propositions  his  is  the  best.  He  promised  something  tangible 
at  once.  The  other  is  like  life  insurance — one  has  to  die  before  it  falls  due. 
Chemically  the  body  comprises  14  elements  in  tangible  quantities,  some 
of  them  very  small,  and  traces  of  a  number  of  others.  In  an  average  body 
of  154  pounds,  there  are  3  pounds  of  nitrogen ;  111  of  oxygen ;  14  of  hydrogen ; 
21  of  carbon ;  2  of  phosphorus ;  2  of  calcium ;  while  of  iron  there  is  100  grains ; 
fluorine  100  grains;  silicon  2  grains;  magnesium  12  grains;  sodium  2  ounces, 
116  g"ains ;  potassium  290  grains ;  chlorine  2  ounces,  47  grains ;  sulphur  2 
ounces,  110  grains.  These  are  the  constants.  The  inconstants  are  the  same 
things  in  greater  quantities,  which  are  used  up  partly  to  replace  tissue,  and 
partly  to  perform  the  work  of  digestion.  The  old-schools  teach  the  carbo- 
hydrate theory  of  diet.  We  teach  the  nitro-phosphate  theory.  Theirs  has 
been  a  failure  for  generations.  Ours  has  been  a  success  for  more  than  a 


244  A  SYSTEM  OF  MATURE  MEDICINE 

generation.  The  reason  is,  ours  is  consistent  with  Nature,  while  theirs  is 
purely  artificial.  As  a  matter  of  fact  the~e  is  but  one  kind  of  chemistry, 
physically,  and  that  is  inorganic.  The  so-called  organic  chemistry,  desig- 
nated as  the  chemistry  of  the  carbon  compounds,  is  a  purely  artificial 
classification,  and  is  consistent  with  only  one  thing,  which  is  the  artificial 
idea  of  medication  to  "cure"  disorders  produced  by  deficient  proportions  of 
the  body  elements,  instead  of  studying  how  to  supply  that  deficiency 
naturally.  The  only  true  organic  chemistry  is  physiological  and  it  is  en- 
tirely different  from  the  physical. 

The  mechanical  body  is  sensory  and  motor,  systemic  and  organic,  in- 
ternal and  external.  Each  division  has  its  peculiar  functions,  some  of  which 
are  voluntary,  under  control  of  the  mind ;  others  are  involuntary,  unde*-  con- 
trol of  instinct,  or  an  automatic  action,  which  is  maintained  so  long  as  life 
lasts. 

Congenital  ills  are 'those  derived  from  the  parents,  and  established  in 
the  child  before  birth ;  they  may  be  physiological,  physical,  or  mental,  or  a 
combination  of  two  or  more.  The  word  "heredity"  has  been  used  to  express 
the  idea  promulgated  in  the  bible  that  "the  sins  of  the  fathers  shall  be  visited 
upon  the  children  even  to  the  third  and  fourth  generations ;"  thus  scaring  the 
public  unnecessarily,  because  the  public  does  not  think,  as  a  rule,  or  it  would 
discover  at  once  that  the  vileness  of  a  pretended  good  god  is  exposed  by  his 
proposition  to  afflict  the  innocent,  unborn  and  unconceived  child  because  of  a 
spite  against  the  parents.  A  father  may  transmit  to  his  child  a  syphilitic  in- 
fection, but  that  is  not  any  god  punishing  the  child,  it  is  a  natural  law,  and 
when  people  understand  how  it  works,  they  will  either  avoid  acquiring  such 
disorders,  or,  having  them,  will  absolutely  avoid  procreation ;  thus  rational 
people  can  see  that  it  lies  within  the  power  of  man  to  defeat  the  alleged 
god  who  makes  threats  against  his  children.  A  child  may  be  born  deficient 
anatomically,  yet  Neurology  will  take  it,  and  by  natural  methods  often  re- 
move anatomical  defects,  and  nearly  always  eliminate  'the  physiological 
troubles,  thus  proving  that  the  spiteful  gods  are  not  in  the  running  with 
those  who  understand  Nature  and  her  laws  reasonably  well. 

Deficiency  may  be  mental,  anatomical,  or  physiological,  or  a  combina- 
tion of  two  or  more.  This  is  why  a  doctor  must  be  posted  with  reference  to 
possible  causes,  such  as  have  already  been  enumerated. 

Debility  in  a  child  is  often  due  to  lack  of  preparation  on  the  part  of  par- 
ents, particularly  the  mother,  before  conception  and  during  the  period  of 
gestation.  The  mother  may  eat  wrongly,  or  have  insufficient  food,  or  over- 
exercise  herself,  or  commit  many  indiscretions  through  ignorance.  We  insist 
that  the  child  has  a  right  to  be  born  well,  and  by  that  we  do  not  mean  simply 
its  physical  and  mental  condition,  but  that  it  should  be  born  into  comfortable 
surroundings  and  opportunities,  and  we  believe  that  every  male  and  female 
should  be  thoroughly  informed  on  the  subject  at  the  very  earliest  possible 
age,  which  is  about  puberty.  We  know  of  nothing  that  has  been  fraught 
with  such  bad  results  to  the  human  race  as  ignorance  of  the  matter  of  pro- 
creation, and  of  sexual  indulgence,  and  that  ignorance  has  been  intensified 
by  an  alleged  "moral"  code,  prepared  and  promulgated  by  those  who  profess 
to  believe  a  personal  god  engineers  everything  for  the  best,  makes  every- 


,  HUMAN  ILLS  AND  THEIR  CAUSES  245 

thing  good,  yet  they  commit  "blasphemy"  by  asserting  that  the  sex  organs 
are  obscene,  subjects  unfit  for  conversation  between  the  sexes.  Could  any- 
thing be  more  silly? 

Infection,  as  we  have  shown,  may  be  derived  congenitally.  It  may 
also  develop  from  wrong  living  without  any  "exposure"  to  any  "contagious" 
disease ;  or,  it  may  be  acquired  by  vaccination,  anti-toxins,  or  any  other  form 
of  serum  therapy;  or,  it  may  be  a  result  of  accident,  such  as  running  a  nail 
in  the  foot  or  a  splinter  in  the  hand ;  or,  it  may  be  "caught"  through  using 
poisonous  drugs.  In  any  case  of  infection,  of  any  sort,  if  the  victim  will  take 
plenty  of  hot  baths  to  keep  relaxed,  there  will  be  no  fever  or  congestion,  and 
if  he  adds  to  that  treatment  restriction  of  his  diet  to  fruit  juices  for  a  week, 
he  will  find  the  so-called  attack  a  very  light  one.  If  it  is  a  case  of  skin 
eruption,  like  small-pox,  erysipelas,  etc.,  a  small  sack  of  table  salt  dissolved 
in  the  bath  water  will  save  others  from  possible  infection,  although  the 
danger  is  very  slight  in  any  event. 

Idiopathic  ills  are  those  which  originate  in  one's  own  body  from  such 
derangements  as  those  which  cause  indigestion,  and  many  of  the  other 
symptoms  called  "diseases." 

Inoculation  may  be  by  accident  or  design.  It  means  that  anything 
which  shocks  or  strains  the  nervous  system,  in  such  a  manner  as  to  bruise 
or  lacerate,  may  develop  infection.  The  rite  of  vaccination,  and  other 
similar  practices,  are  monuments  to  medical  ignorance,  and  the  statutes- pro- 
viding for  compulsory  vaccination  are  disgraces  to  legislatures  and  courts 
who  uphold  their  acts.  The  Illinois  Supreme  Court,  and  a  number  of  others, 
have  honored  themselves,  and  protected  thousands  of  people  by  declaring  that 
"a  healthy  child  is  not  a  menace  to  its  fellows  in  school,"  and  that  any 
school  board  which  refuses  such  a  child  admission  to  school  because  it  has 
not  been  vaccinated,  is  liable  to  a  suit  for  damages  by  the  parents.  In 
England,  where  they  "discovered"  vaccination,  and  made  compulsory  laws  in 
favor  of  the  Doctor's  Trust,  the  results  were  so  appalling,  as  exhibited  in 
the  rapid  increase  of  cancer,  syphilis,  erysipelas,  and  other  malignant  dis- 
orders, that  they  repealed  the  law,  and  all  efforts  to  reinstate  it  have  failed. 
American  liars  have  asserted  during  the  great  war  that  inoculation  against 
typhoid  and  small-pgx  are  compulsory  in  the  British  Army  and  Navy.  I 
have  a  letter,  dated  May  10,  1916,  from  the  office  of  the  Registrar  General, 
London,  saying  the  story  is  a  lie,  that  "the  matter  is  absolutely  voluntary, 
although  the  rite  is  accepted  in  the  majority  of  cases."  That  is  not  astonish- 
ing in  view  of  the  ignorance  and  credulity  of  people.  They  say  prayers  too ; 
then  they  go  into  battle  "damning  Hell  out  of  things." 

The  mechanical  body  includes  all  parts  which  operate  wholly  or  partially 
in  a  mechanical  manner,  whether  it  be  locomotor  or  otherwise. 

The  systemic  body  is  divided  in  two  classes,  the  internal  and  external, 
and  each  of  these  has  the  duality  chemistry  and  mechanics.  The  internal 
systemic  body  comprises  nerves  and  blood  vessels,  a  digestive  tract,  a  system 
of  lymphatics,  and  several  egestive  provisions,  in  all  of  which  mechanics  is 
exhibited  in  the  motions,  from  molecular  vibration  to  osmosis,  which  is  the 
passage  of  liquefied  matter  through  the  walls  of  vessels,  and  through  the 
structures  of  tissues. 


A  SYSTEM  OF  MATURE  MEDICINE 


The  organic  body  comprises  the  organs  of  special  sense,  the  brain,  lungs, 
heart,  stomach,  spleen,  pancreas,  liver,  kidneys,  bladder  and  sex  organs. 
Some  of  these  are  mechanical  and  some  chemical  representatives.  The  eyes 
and  ears  are  mechanical.  The  organs  of  taste  and  smell  are  chemical  in  their 
action.  The  lungs  act  mechanically  to  discharge  carbon-dioxide,  and  take 
on  oxygen,  hence  they  are  chiefly  mechanical.  The  heart  is  mechanical, 
being  nothing  but  a  pump  and  a  syphon. 

Internally,  not  only  means  within  the  cavities  of  the  body,  but  it  means 
within  the  cavities  of  structures  within  the  body;  also  it  refers  to  a  position 
on  the  side  of  a  body  within  the  body,  such  as  internal  recti  of  the  eyes, 
where  we  have  also  the  external  recti,  and  other  muscles  on  the  outside  of 
the  globe,  all  of  which  are  called  extra-ocular ;  then  we  have  the  internal 
muscles  of  accommodation,  etc.,  which  are  called  intra-ocular.  We  also  have 
the  internal  and  external  carotid  arteries,  and  the  internal  and  external  iliac 
arteries,  with  veins  to  correspond. 

External  is  the  opposite  to  internal  in  all  respects  mentioned  above,  and 
we  are  able  to  form  some  opinion  about  a  person's  condition  from  the  ex- 
ternal exhibits ;  but  they  are  not  final,  nor  analyzable,  until  we  have  gone  the 
limit  of  a  detailed  examination. 

Sensory  refers  to  not  only  the  special  senses,  but  the  general  sense  of 
feeling,  and  it  covers  a  very  broad  field.  It  is  the  connecting  link  between 
chemistry  and  mechanics  everywhere  in  the  body.  It  is  mental,  as  well  as 
physiological,  and  the  mental  dominates  in  a  manner  very  fortunate  for  us, 
because  it  enables  us  to  prove  to  people  that  many  of  their  ills  are  due  en- 
tirely to  ignorance,  and  to  a  weakened  condition  of  the  mental  sense  by  al- 
leged education,  and  we  prove  it  in  this  way :  Patients  come  to  us  with 
tales  of  woe  that  would  make  a  cigar-store  Indian  weep;  they  evidently 
regard  their  ills  as  valuable  assets ;  they  are  even  proud  to  report  that  all 
the  doctors  have  said  their  cases  are  incurable,  and  so  long  as  we  tolerate  it, 
they  will  rattle  away ;  we  may  s^ay  all  kinds  of  mean  things  about  the  bugs 
and  the  cruelty  of  the  disease ;  but  when  we  tell  them,  blandly,  they  are  cer- 
tainly in  as  bad  a  fix  as  they  claim,  and  even  worse  than  they  realize,  that 
their  mentalities  are  in  just  as  bum  a  condition  as  their  physical  bodies,  they 
snort ;  ego  comes  to  the  front,  and,  in  their  ignorance,  they  make  the  fool 
assertion  that  their  mentality  is  all  right.  We  then  tell  them  that  practically 
all  insane  people  say  the  same  thing.  Then  they  get  angrier,  but  when  we 
tell  them  firmly,  that  we  know  all  about  their  situation,  and  know  it  is  so 
bad  we  do  not  want  their  cases  at  any  price,  they  generally  come  down  off 
their  high  horses  and  beg.  Having  won  our  point,  we  quickly  proceed  to 
clinch  the  case  by  getting  a  guarantee  fee  that  they  will  follow  instructions, 
and  we  win  every  case. 

The  motor  apparatus  of  the  body  is  locomotor  and  vasomotor  chiefly, 
although  some  people  can  work  their  ears,  and  all  of  us  work  our  jaws. 
Also,  as  remarked  before,  too  many  wag  their  tongues,  spreading  vile  tidings, 
and  inoculating  innocent  persons  with  fake  religions,  ''morals,"  and  other 
stuff,  which  amounts  on  the  whole  to  the  worst  kind  of  a  mental  disease, 
developing  the  symptoms  suspicion,  jealousy,  and  all  that  goes  with  them. 

Real  ills  are  those  giving  off  physiological  symptoms,  which  we  find  by 


HUMAN  ILLS  AND  THEIR  CAUSES 


objective  and  subjective,  dynamic  and  static  tests.  They  may  be  real  body 
ills,  or  real  mental  ills.  In  either  case  both  will  soon  be  involved  through 
their  status  of  inter-dependence.  Neurologists  and  Ophthalmologists  are 
taught  all  of  these  details  with  great  care,  and,  while  we  think  our  graduates 
are  far  and  away  superior  to  those  of  other  schools,  we  regret  to  say  that 
we  frequently  note  a  tendency  to  carelessness,  not  toward  their  patients,  but 
toward  themselves,  among  our  graduates.  We  mean  that  they  do  not  take 
the  interest  in  adding  to  their  fund  of  knowledge  that  they  should.  If  this 
little  "crack"  at  them  will  wake  them  up,  and  get  them  to  work,  the  space 
is  well  given. 

Among  the  real  ills  are  those  caused  by  the  emotions,  and  we  have  found 
that  nervous  strain  through  the  mentality  is  about  the  worst  form  there  is. 
It  is  like  burning  ammunition  on  the  ammunition  wagon  ;  it  goes  and  there 
is  no  result  except  the  loss  of  the  ammunition.  We  seek  to  gain  our  pa- 
tients' confidences,  and  are  often  able  to  suggest  something  which  diverts 
their  attention  from  the  cause  of  worry  at  least  temporarily,  and  sometimes 
we  have  been  able  to  make  it  permanent  by  reasoning  with  them,  and  by 
attending  to  the  causes  of  their  physiological  derangements. 

One  of  the  extreme  forms  of  mental  ills  is  hysteria.  Speaking  strictly, 
this  would  only  apply  to  women,  but  it  is  usually  used  to  describe  mental 
excitability  in  both  sexes.  It  varies  in  degree  from  that  violence  known  as 
insanity  to  simple  fits  of  temper,  fear,  hilarity,  etc.  Such  patients  are  some- 
times hard  to  get  under  control,  and  we  have  to  be  very  firm,  but  so  far  as 
their  deranged  physiology  is  concerned,  they  are  comparatively  easy. 

The  other  extreme  of  mental  troubles  is  melancholy,  which  is  bad  be- 
cause it  is  a  condition  far  below  normal.  Patients  often  lose  ambition  to  get 
well,  and  if  we  cannot  restore  it  after  a  few  weeks,  we  may  still  be  able  to 
partly  restore  the  physiological  body;  but  such  are  not  easy  cases  by  any 
means.  Happily,  there  is  a  class  who  are  intermittently  hysterical  and  mel- 
ancholy, which  is  analogous  to  clonic  spasm  physiologically,  and  our  efforts 
in  both  hysteria  and  melancholy  is  to  get  that  intermittence  going,  when  our 
case  is  practically  won. 

Accidental,  as  used  in  the  diagram,  means  incidental  as  well  as  the 
popular  understanding  of  the  word. 

Accidental  real  mental  ills  may  come  from  the  shock  of  fright,  or  from 
the  receipt  of  appalling  news,  and  there  have  been  cases  reported  in  which 
patients  died  instantly;  but  we  do  not  believe  such  effects  possible  if  the 
physiological  body  is  in  good  condition. 

Strain  upon  the  nervous  system  through  the  mind  may  be  -accidental, 
that  is,  it  may  come  to  a  person  through  no  fault  of  his  own,  and  it  may 
be  so  great  as  to  simply  exhaust  the  nerve  supply.  Just  how  it  is  done  no- 
body has  yet  discovered  any  more  than  they  have  discovered  how  certain 
chemical  elements  control  the  rearrangement  of  other  elements  in  forming 
new  combinations  ;  so  far  as  the  physical  exhibit  goes,  they  take  no  part 
in  it,  yet  we  know  they  are  necessary  because  the  other  combination  will 
not  take  place  unless  those  elements  are  present. 

False  illnesses  are  very  common,  chief  among  which  are  those  who 
have  been  reared  on  the  theory  of  hope  and  fear;  who  are  so  ignorant  and 


A  SYSTEM  OF  MATURE  MEDICINE 


heedless  that  they  listen  to  everything  every  gabby  person  says,  anft  with  a 
peculiarly  constituted  mental  apparatus,  their  sympathy  develops  what  every- 
body else  has,  either  in  order  to  be  popular,  or  to  give  a  physical  demonstra- 
tion of  their  sympathy.  Some  are  actual  malingerers,  and  we  believe  we 
have  the  only  system  of  practice  that  will  catch  them.  We  have  had  a  lot 
of  fun  with  this  class  and  have  done  a  lot  of  good,  gaining  the  thanks  and 
appreciation  of  the  afflicted  relatives  and  friends. 

Education  along  false  lines  predisposes  people  to  certain  classes  of  ills. 
In  the  old  schools  of  medicine,  it  is  notorious  that  the  majority  of  students 
develop  symptoms  of  nearly  all  the  ills  the  lecturers  talk  about  during  the 
first  year,  and  many  find  themselves  so  totally  unfitted  for  the  work  they 
drop  out,  never  finishing  the  course. 

Another  sort  of  education  is  environment,  that  is,  where  people  are 
hearing  all  kinds  of  complaints ;  reading  silly  newspaper  stories,  particularly 
by  the  "health  editors"  and  by  city  health  commissioners,  who  are  usually 
cheap  doctors  and  tricky  politicians. 

Education  and  environment  have  sometimes  a  benign  effect,  that  is  peo- 
ple only  have  mild  cases  of  disease-phobia,  and  with  a  little  reasoning,  either 
through  circulars  of  information,  or  personal  talks,  they  recover  before 
much  damage  is  done. 

On  the  other  hand  there  is  a  malignant  development  in  some  people  to 
such  an  extent  that  if  told  they  have  been  "exposed"  to  small-pox,  they  will 
develop  cases  in  a  few  days.  Happily  there  are  only  a  few  who  are  so  easily 
affected  bodily  through  the  mind,  but  there  are  thousands,  yes,  hundreds  of 
thousands,  whose  mentalities  develop  something  analogous  to  small-pox  sim- 
ply through  fear  superinduced  by  credulity.  They  are  permitted  to  run  at 
large,  but  are  liable  to  become  violent  at  any  moment. 

Positive  influences  may  be  good  or  bad.  The  patient  is  generally 
affected  by  the  bad  one,  and  we  must  produce  the  antidote  in  our  own 
positiveness.  If  we  can  make  a  patient's  position,  with  reference  to  his 
imaginary  ills,  absolutely  ridiculous,  we  can  win  all  the  time. 

Then  there  is  a  negative  class  who  develop  imaginary  ills  from  subtle 
influences  in  a  sort  of  a  negative  way.  As  a  rule,  they  are  dull,  could  not 
see  a  joke  until  the  next  day;  could  not  learn  mathematics  of  the  simplest 
kind  in  any  time ;  they  are  devoid  of  imagination.  Our  only  possible  nega- 
tive treatment  of  these  people  would  be  to  refuse  to  touch  the  cases.  Neu- 
rology is  always  positive,  and  positive  to  the  last  ditch.  This  is  the  reason 
we  insist  that  all  students  in  our  school  make  a  grade  of  100  per  cent,  in 
physics  in  order  to  graduate,  and  it  must  not  be  understood  for  a  minute 
that  our  physics  is  a  simple  thing.  The  first  hundred  pages  of  this  book 
will  give  a  fair  sample  of  what  our  physical  optics  is,  compared  with  others, 
and  when  it  comes  to  physical  chemistry,  we  have  greater  complications. 
But  people  who  know  physics,  know  how  to  be  positive  and  make  good. 

Causes  of  human  ills  have  been  classified  in  ten  departments  early  in 
this  chapter,  and  all  of  them  have  been  condensed  into  the  proposition,  nerve 
shock  or  strain.  The  second  diagram  subdivides  the  subject  of  causes,  and 
the  words  apply  in  a  general  way,  at  least,  in  accordance  with  the  coming 
paragraphs : 


HUMAN  ILLS  AND  THEIR  CAUSES  249 

Chemical  causes  are  in  considerable  variety.  These  may  be  divided  into 
two  classes;  Congenital  and  acquired,  and  each  of  these  is  subject  to  further 
divisions,  as  will  be  shown.  Body  chemistry  is  a  very  complex  thing.  It 
may  be  put  in  a  state  of  confusion  by  the  presence  of  too  much  of  one  ele- 
ment or  not  enough  of  another.  This  has  been  one  of  the  great  weaknesses 
of  old-school  medicine.  They  paid  no  attention  to  the  chemical  qualities 
of  food,  and  do  not  know  enough  about  the  subject  to  realize  the  possibilities 
of  combinations  of  food  and  medicine  to  develop  very  dangerous  conditions. 
They  have  learned  that  when  they  give  mercury,  the  patient  should  not  eat 
sweets  or  sours,  nor  drink  hot  or  cold  drinks,  but  that  was  no  more  than 
any  layman  might  learn  by  experience.  We  teach  our  Ophthalmologists  a 
sufficient  abstract  of  dietetics  so  that  they  know  how  to  keep  their  patients 
going  in  the  right  direction  in  food  matters,  although  it  is  not  possible  in  the 
Ophthalmological  course  to  give  details  chemically,  because  it  is  necessary 
to  know  more  about  general  anatomy  and  physiology.  Hence,  only  Neu- 
rologists are  able  to  call  themselves  dieticians,  and  we  advise  them  not  to 
do  that,  but  to  refer  to  their  dietetics  as  Neurologists'  Materia  Medica. 

For  the  same  reason  that  we  have  congenital  ills,  there  must  be  con- 
genital causes,  and  they  have  been  mentioned  in  a  preceding  paragraph  as 
a  deficiency  and  debility  resulting  from  improper  care,  education,  diet,  and 
general  habits  of  living. 

The  mentality  as  a  factor  in  causing  ills,  congenital  or  otherwise,  is  a 
very  potent  one.  Mothers  may  brood  over  troubles,  or  be  mentally  affected 
by  gossipy  neighbors,  during  the  period  of  gestation,  or  a  child,  while  grow- 
ing up,  may  have  foolish  advisers,  or  foolish  parents  who  neglect  to  advise 
them  at  all,  and  may  allow  his  passions  to  get  him  into  trouble,  or  his 
emotions  may  be  involved  until  his  mentality  is  warped. 

Mental  shocks  upset  the  nervous  system  almost  as  badly  as  a  rule, 
and  sometimes  worse  than  any  physical  shock  would.  As  stated  elsewhere, 
we  do  not  believe  that  if  a  child  was  rightly  reared,  and  his  physiological 
errors  corrected,  there  would  ever  be  any  danger  of  death  from  mental  shock. 
We  teach  our  students  and  our  patients  to  cultivate  a  fine  mental  control, 
which  will  render  them  immune  from  such  bad  effects.  To  illustrate  this, 
I  have  had  the  shock  of  losing  two  sons  within  a  week  from  diphtheria, 
which  baffled  the  old-school  doctors  in  charge  completely.  One  of  the  boys 
was  seventeen,  and  the  other  fifteen ;  the  elder  one  died  standing  on  his 
feet,  holding  me  by  the  coat  lapels,  and  begging  me  to  save  him — he  was  chok- 
ing to  death  from  antitoxin.  The  other  died  just  a  week  later  from  kidney 
trouble,  which  frequently  follows  diphtheria.  If  I  had  not  cultivated  self- 
control,  those  deaths  and  surrounding  circumstances  would  have  unbalanced 
my  mind,  but  I  reasoned,  and  that  saved  me.  Not  only  that;  it  made  me 
determine  to  go  ahead  and  study  and  develop  what  was  then  a  system  of 
optical  practice  into  a  system  of  general  practice,  which  would  be  so  nearly 
perfect  it  would  teach  people  how  to  live  so  they  may  be  completely  immune 
from  all  such  possibilities.  It  is  still  a  fact,  however,  that  no  one  has  ever 
yet  found  a  specific  cause  for  the  so-called  childrens'  diseases ;  they  develop 
from  obscure  causes  and  run  their  course  quickly.  We  are  able  to  say  that 
there  has  not  been  a  case  of  diphtheria,  scarlet  fever,  measles,  mumps,  or 


250  A  SYSTEM  OF  MATURE  MEDICINE 

anything  similar  in  any  of  the  families  who  have  lived  Neurologically  during 
the  last  seventeen  years.  Therefore,  we  believe  we  have  the  nearest  a  per- 
fect system  that  has  ever  been  offered. 

Mental  strain  sometimes  comes  without  shock,  and  sometimes  follows 
shock.  One  of  the  commonest  causes  of  strain  is  familiarly  known  as  the 
"green-eyed  monster,"  jealousy.  This  is  the  most  annoying,  disgusting 
exhibition  of  self-love  that  we  can  conceive  of.  Some  have  claimed  jealousy 
of  <me  person  toward  another  is  proof  of  love  for  that  other.  This  is  a  lie. 
It  is  proof  of  an  arrogant,  overbearing  self-love.  It  inspires  the  most  con- 
temptible acts  on  the  part  of  those  afflicted  with  it,  and  children  should  be 
taught  to  avoid  it  as  they  would  a  plague.  Another  form  of  strain  is  the 
worry  of  parents  over  children.  This  need  hot  be  if  children  are  taught  as 
they  should  be,  that  they  hold  the  family  reputation  at  their  mercy,  and  are 
encouraged  to  ask  questions  from  early  infancy;  they  may  be  educated  to 
enjoy  life  without  worrying  their  parents.  I  so  taught  my  children,  and  I 
never  had  a  moment's  worry  from  their  acts ;  they  were  reliable,  gentlemanly, 
well-informed,  not  only  of  their  own  anatomy  and  physiology,  but  of  matters 
and  things  in  general.  They  were  popular  with  neighbor  boys  and  girls  and 
their  parents.  Their  influence  among  others  was  good,  as  quite  a  number 
informed  me  at  the  time  of  their  death.  I  have  known  a  great  many  families 
who  taught  their  children  real  things  instead  of  catechism,  codes,  morals, 
etc.,  and  I  cannot  recall  a  single  case  where  the  children  of  such  families 
ever  caused  their  parents  nerve  strain. 

Physical  congenital  chemical  causes  are  restricted  to  acts  of,  and  injuries 
to,  the  mother  during  pregnancy.  It  is  a  pitiable  fact  that  in  this  country  we 
have  alleged  "moral  laws"  which  prevent,  to  a  large  extent,  even  physicians 
from  giving  information  relative  to  the  hazards  of  pregnancy,  while  the  Gov- 
ernment itself  circulates  by  the  carload  information  how  to  breed  pigs  and 
cattle.  This  is  all  because  the  constitution  is  violated  deliberately  and 
directly  with  reference  to  the  paragraph  which  says :  "No  law  shall  be  passed 
respecting  the  establishment  of  a  religion."  I  know  of  only  one  thing  more 
contemptible  than  politics,  and  that  is  religion/ 

Physical  defects  may  come  from  mal-nutrition.  For  example,  if  the 
food  eaten  by  a  pregnant  mother  does  not  contain  bone-forming  elements, 
there  will  be  a  deficiency,  not  only  in  the  bones,  so  far  as  the  strength  is 
concerned,  but  with  reference  to  the  condyles  and  sockets  for  articulation. 
If  there  is  a  deficiency  in  the  material  necessary  for  the  development  of 
nerves,  and  muscular  structures,  and  nervous  energy  to  operate  those  struc- 
tures, the  child  will  be  a  weakling.  Mal-nutrition  is  not  so  much  a  deficient 
quantity  of  food,  as  it  is  a  matter  of  deficient  quality.  The  daughter  of  one 
of  the  wealthiest  men  in  America  is  a  cripple,  and  always  will  be,  because 
her  parents  were  ignorant,  and  there  was  a  deficient  supply  of  essential  ele- 
ments not  only  before  birth  but  after.  Surgery  has  benefited  her  sOme,  but 
she  is  not  like  other  girls. 

Infection  may  come  about  physically  even  before  birth,  that  is,  a  mother 
may  pass  through  an  accident  while  carrying  the  child  which  does  not  kill 
it,  but  bruises  it,  and  a  condition  result  which  will  interfere  with  the  de- 


HUMAN  ILLS  AND  THEIR  CAUSES  251 

velopment,  producing  deformities,  and  often  an  infection  which  will  even- 
tually cause  death  after  a  few  miserable  years  of  life. 

Acquired  chemical  ills  are  probably  the  most  common  ones.  There 
are  so  many  opportunities  for  it.  People  eat  from  three  to  five  times  a  day, 
and  indulge  their  tastes  until  they  work  their  body  chemistry  to  death. 

Nearly  all  of  the  acquired  chemical  ills  are  induced  voluntarily;  people 
read  breakfast  food  advertisements  and  become  hypnotized  into  the  belief 
that  it  is  food;  they  will  even  eat  fine  shavings  if  it  is  labeled  "shredded 
wheat."  They  read  patent  medicine  advertisements,  describing  symptoms 
of  alleged  fearsome  diseases,  they  find  that  they  have  some  of  them,  and 
they  begin  to  dope  themselves.  The  patent  medicine  concerns  of  this  coun- 
try get  $165,000,000  a  year  out  of  a  gullible  public.  The  Medical  Trust  has 
on  foot  a  scheme  to  put  these  manufacturers  out  of  business.  They  claim, 
if  they  can  succeed,  that  there  will  be  $165,000,000  for  the  doctors.  Yet  they 
profess  to  be  getting  rid  of  the  patent  medicine  men  to  protect  the  dear 
public. 

Involuntary  chemical  ills  are  those  which  are  produced  innocently  from 
the  voluntary  practice  of  eating.  Of  course,  the  victims  do  not  know  the 
chemistry  of  their  food,  and  if  they  ask  the  family  physician,  he  will  tell  them 
that  the  combustion  of  carbonaceous  matter,  such  as  sugar,  butter,  chocolate, 
bread,  potatoes,  etc.,  in  the  process  of  digestion,  is  what  creates  body  heat 
and  energy.  This  is  not  true,  but  if  it  were,  that  would  not  make  it  good 
food,  because  it  does  not  contain  the  essential  elements  with  which  to  re- 
build the  tissues,  and  the  American  text-book  of  Physiology  admits  it. 
The  book  referred  to  is  the  product  of  the  Professors  of  Physiology  in  the 
Medical  departments  of  Harvard,  Yale,  Columbia,  University  of  Pennsyl- 
vania and  Johns  Hopkins.  We  use  it  in  our  school-room  as  a  reference 
book  to  prove  to  our  students  that  the  old-schools  know  nothing  about 
dietetics  and  admit  it. 

Habitual  Chemical  Causes  are  those  which  develop  nervous  irritation 
or  exhaustion  by  their  poisonous  effects.  Drugs,  liquor,  tobacco,  and  such 
practices  as  masturbation  by  males,  are  contributing  causes  to  those  de- 
scribed under  the  eating  habit. 

Occupational  Causes  are  those  which  involve  hazard,  such  as  working 
in  the  fumes  of  acids  or  other  chemicals.  There  are  many  possibilities,  among 
them  painters'  colic ;  and  inhaling  of  bad  air,  whether  it  be  in  a  sweat-shop 
or  in  a  swamp  in  the  country,  produces  infection.  Then,  of  course,  there 
are  the  physical  hazards  from  aeroplane  to  the  innocent  by-stander  in  a 
street  row  or  accident. 

Atmospheric  Causes  involve  exposure  to  weather,  climatic  conditions, 
excessive  heat  or  cold,  and  the  re-actions  therefrom.  In  the  "swamps"  of 
Louisiana,  people  who  intend  to  continue  residence  during  the  summer, 
go  in-doors  at  sundown,  and  do  not  come  out  until  sometime  after  sunup,  in 
order  to  avoid  malaria,  or  what  they  call  "break-bone"  fever.  The  popular 
idea  that  consumption  is  due  to  climatic  conditions  is  a  mistaken  one.  It 
is  true  that  some  people  with  such  tendencies  have  gone  from  one  part  of 
the  country  to  another,  and  apparently  escaped  the  grim  reaper,  but  most 


252  A  SYSTEM  OF  MATURE  MEDICINE 

of  them  died  soon,  and  would  have  done  so  anywhere  unless  they  fell 
into  the  hands  of  a  Neurologist,  when  if  they  measured  up  to  a  point 
above  their  danger  line,  the  majority  of  them  would  have  been  relieved  of 
the  causes  of  the  troubles,  which  were  not  atmospheric,  but  were  very  abun- 
dant in  other  directions. 

Accidental  causes  are  different  from  those  referred  to  in  mentioning 
the  aeroplane,  etc.,  although  in  a  way  those  are  accidents,  but  in  this  dia- 
gram, accident  is  limited  to  the  most  unexpected  things,  possible  but  not 
probable.  When  a  person  goes  up  in  an  aeroplane,  it  is  not  only  possible, 
but  very  probable  that  there  is  going  to  be  a  funeral ;  the  same  is  true  when 
he  goes  to  work  on  a  high  building,  where  he  stands  on  a  foot  square  space 
and  tries  to  catch  hot  rivets  with  a  nail  keg.  This  paragraph  refers  to  the 
most  unexpected  things,  and  as  a  rule  trifling  things,  which  are  neglected 
and  develop  serious  trouble.  The  object  of  all  these  paragraphs,  I  repeat, 
is  to  encourage  doctors  to  study  little  details. 

Mechanical  causes  are  sometimes  combined  with  chemical  ones,  and 
they  always  act  through  the  chemical  field,  except  when  they  cause  instant 
death.  As  we  are  not  talking  about  deaths,  but  are  covering  disorders,  this 
statement  holds  good.  One  may  have  a  trifling  scratch,  or  a  bruise,  caused 
deliberately  or  accidentally,  and  it  may  develop  very  serious  consequences 
chemically.  For  example,  a  person  who  is  addicted  to  frequent  nose-bleeding' 
is  always  very  easily  bruised,  and  thumping  him  deliberately  in  the  manner 
a  darky  does  a  water-melon,  when  he  is  testing  it,  is  sufficient  to  cause  dis- 
coloration, and  that  means  coagulated  and  clogged  blood.  Or  the  same 
thing  may  happen  accidentally,  and  in  either  case  the  blow  be  so  light  it  is 
not  felt,  yet  such  cases  sometimes  result  in  blood  poison.  The  pricking 
of  a  finger  with  a  needle  or  pin  may  set  up  an  irritation  that  will  cause 
lockjaw.  And  there  need  be  no  "bugs"  on  either  the  needle  or  the  pin.  In 
the  hands  are  the  palmar  nerve  plexuses,  and  in  the  feet  are  the  plantar 
nerve  plexuses.  Under  the  arms,  in  the  groins,  and  elsewhere,  about  the 
body  are  nerve  plexuses,  and  a  mechanical  injury  to  any  one  of  those,  even  if 
there  be  no  laceration,  may  cause  very  dangerous  disorders. 

The  anatomical  mechanical  causes  are  that  class  in  which  some  part  of 
the  anatomy  employed  mechanically  is  involved.  It  may  be  an  injury  to 
the  skull,  the  mechanical  function  of  which  is  merely  to  enclose  the  brain; 
or  an  accident  to  the  back  may  interfere  with  movements,  from  breathing  to 
locomotion. 

Physiological,  mechanical  causes  are  largely  those  of  obstruction,  such 
as  exhibit  constipation,  boils,  etc. 

Skeletal  causes  are  limited  to  the  bony  system,  and  if  there  has  been  a 
deficient  supply  of  material  to  build  these  bones,  they  will  be  too  hard  or 
too  soft,  hence  their  mechanical  capacity  is  weakened. 

The  first  probability  among  skeletal  causes  is  fractures,  and  not  only 
doctors,  but  every  individual,  should  learn  something  about  these,  in  order 
that  first  aid  may  be  rendered.  Many  times  physicians  have  been  blamed 
for  bad  jobs  of  healing,  when  the  chief  reason  was  they  were  not  called  soon 
enough.  Too  many  people  are  frightened  at  pain,  or  are  afraid  of  causing 
pain,  hence  neglect  to  do  what  they  might. 


HUMAN  ILLS  AND  THEIR  CAUSES  253 

Another  of  the  skeletal  causes  is  dislocations,  and  these  are  not  under- 
stood as  they  should  be.  The  average  doctor  sets  a  dislocation  by  main 
strength  and  awkwardness,  when,  if  he  would  study  his  anatomy,  par- 
ticularly of  the  joints,  and  of  the  muscles,  he  would  be  able  to  fix  cases 
easily.  Of  course,  if  a  person  falls  and  dislocates  a  riip,  and  is  picked  up, 
carried  to  bed,  or  possibly  several  miles  to  a  doctor,  the  dislocation  may  be 
aggravated,  and  considerably  interfere  with  setting,  because  of  the  addi- 
tional irritation  and  congestion..  Whenever  possible,  the  victim  of  such  an 
accident  should  remain  where  he  fell  until  a  doctor  is  called,  when  very  often 
resetting  is  very  easy  and  results  are  fine. 

Muscular  causes  are  often  developed  by  athletics  or  special  training 
in  some  direction  where  a  hypertrophy  develops,  and  this  is  always  followed 
by  atrophy,  unless  the  case  is  treated  soon  enough  to  prevent  it.  Also 
non-use  of  muscles,  or  a  muscle  in  a  state  of  under-development  so  that 
when  called  upon  in  emergency,  it  may  fail  to  act,  add  to  the  possibilities  of 
trouble. 

Or  muscles  may  be  cut  accidentally,  or  otherwise,  and  permanent  bad 
results  be  the  consequence.  For  example,  in  operating  for  hip-joint  dis- 
locations, surgeons  almost  invariably  so  injure  the  muscles  that  the  victim 
is  a  permanent  cripple.  Some  of  our  brag  Chicago  surgeons  rank  high 
among  the  guilty  ones. 

Sprains  may  put  muscles  out  of  business  temporarily,  or  permanently, 
and  they  go  even  further,  because  what  is  commonly  known  as  a  sprain  is 
often  a  tearing  loose  of  a  ligament  from  its  attachment  to  a  bone  or  muscle, 
and  the  healing  process  is  always  slow.  For  such  conditions,  use,  to  a 
reasonable  extent,  is  a  good  thing.  It  irritates  just  enough  to  promote  re- 
pairs ;  also  plenty  of  hot  water  is  good.  This  is  also  the  treatment  for  dis- 
locations, because  it  keeps  down  fever,  reduces  pain  and  promotes  healing. 

In  physiological  mechanical  causes  we  have  a  subdivision,  the  first  item  of 
which  is  systemic.  This  refers  to  the  circulatory,  digestive,  lymphatic,  ner- 
vous systems,  and  all  of  their  connections. 

The  nervous  branch  is  one  which  involves  both  sensation  and  motion, 
hence  it  is  our  most  valuable  ally  in  handling  a  case. 

The  vascular  system  has  its  own  peculiarities,  being  lymphatic,  arterial 
and  venous,  having  special  qualities  and  quantities,  it  ranks  second  only 
to  the  nervous  system  in  our  work. 

The  organic  functions  being  both  mechanical  and  chemical,  some  of 
them  chiefly  one  or  the  other,  and  some  about  equally  divided  between  the 
two,  we  have  a  subject  for  study  that  is  intensely  interesting,  and  absolutely 
one  of  the  broadest  the  physician  has  to  tackle.  This  statement  is  doubly 
true  because  it  not  only  combines  the  nervous  and  muscular  systems,  but  it 
connects  the  mental  with  the  vascular. 

Among  mechanical  causes  we  have  those  which  may  be  classed  as  purely 
imaginary,  partly  the  product  of  the  patient's  own  brain,  but  largely  from 
listening  to  the  stories  of  others,  and  sometimes  through  sympathy.  Neu- 
rology offers  the  only  means  we  know  of,  by  which  such  cases  can  be 
differentiated. 


254  A  SYSTEM  OF  MATURE  MEDICINE 

The  real  organic  ills  are  not,  as  a  rule,  of  that  class  commonly  understood 
to  be  "diseased."  They  are  simply  disabled,  partially  or  wholly  from  a 
lack  of  power  to  operate  them.  The  weakness  of  the  old-school  treatment  of 
such  cases  is  that  it  undertakes  to  repair  a  part,  when,  as  a  matter  of  fact, 
the  entire  anatomy  and  physiology  needs  overhauling.  When  a  machine  is 
taken  to  a  shop  to  have  certain  things  repaired,  it  is  assumed  by  the  me- 
chanic, if  he  is  a  good  one,  that  he  is  authorized  to  fix  everything  that  is 
needed  to  make  it  work  normally,  and  if  he  does  not  assume  that  he  very 
soon  does  no  business,  because  if  the  machine  does  not  work  after  he  repairs 
it,  he  is  blamed.  The  same  thing  is  true  in  medical  practice,  or  in  the  prac- 
tice of  any  profession.  We  instruct  our  students  in  all  departments  that 
when  a  case  is  brought  to  them,  or  comes  of  its  own  accord,  to  make  an 
examination  and  an  analysis,  and  charge  a  fee  for  it,  so  they  can  afford  to 
take  the  time  to  do  it  right ;  then,  if  they  find  they  can  fix  it,  they  take  the 
case,  provided  the  patient  agrees  to  conform  to  natural  law,  as  interpreted  by 
us,  and  to  not  consult  others,  layman  or  doctor,  while  in  our  care.  Neu- 
rology and  Ophthalmology  will  not  mix  with  other  systems  any  more  than 
oil  and  water  will  mix. 


Fight  against  vaccination  as  you 
value  your  health  and  constitutional 
rights.  It  is  the  worst  of  all  artificial 
causes  of  human  ills.  Even  medical 
fanatics  concede  the  danger  of  inocu- 
lating sickly  children.  Illinois  supreme 
court,  in  forbidding  compulsory  vac- 
cination by  school  boards,  said :  "A 
healthy  child  is  not  a  menace  to  so- 
ciety." 


CHAPTER  XXX. 
The  Color  Sense.     Color  Ignorance.     Theories  of  Color-Blindness. 

On  pages  25,  26,  32,  33,  85,  reference  was  made  to  the  chromatic  and 
spherical  aberration  caused  by  strong  prisms  and  curvatures,  and  on  page 
85  a  drawing  shows  how  a  lens  is  constructed  to  reduce  those  faults  to  a 
negligible  quantity  by  employing  "crown"  and  "flint"  glass,  having  different 
indexes  of  dispersion. 

The  fact  that  the  crystalline  lens  of  the  eye  is  constructed  similarly  en- 
ables us  to  offer  physical  evidence  in  support  of  our  theory  of  color-blind- 
ness and  its  cause.  The  Young-Helmholz  theory  of  "color-perceiving  ele- 
ments in  the  rods  and  cones  of  the  retina"  never  appealed  to  good  judgment, 
because  it  was  a  product  of  imagination,  with  nothing  rational  to  support  it. 
Another  theory  advanced  was  that  there  exists  in  the  retina  three  different 
visual  substances,  viz :  "red-green,  blue-yellow  and  white-black ;"  it  was 
claimed  that  "one  color  of  each  pair  is  used  up  by  the  process  of  dissimila- 
tion and  the  other  is  produced  by  a  creative  process  called  assimilation ;" 
that  "white  corresponds  to  the  process  of  dissimilation,  and  black  to  the 
process  of  assimilation ;"  that  "for  the  two  other  pairs  it  cannot  be  said 
which  color  represents  either  process."  Another  theory  was  that  "we  know 
everything  by  comparison  with  some  other  thing — a  large  man  by  compari- 
son with  one  we  know  to  be  average  size ;  a  red  color  by  comparison  with 
yellow ;  black  by  comparison  with  white."  All  of  which  appear  equally 
fallacious  to  us. 

It  can  be  understood  readily  that  with  such  short  radii  and  consequent 
strong  curves  as  are  presented  by  the  crystalline  lens,  its  chromatic  and 
spherical  aberration  would  be  very  great  if  the  lens  was  of  homogeneous  con- 
struction. We  find  that  it  is  heterogeneous,  even  to  the  extent  of  com- 
bining many  more  layers  than  are  employed  in  making  the  aplanatic  lenses 
described.  Therefore  it  is  reasonable  to  assume  that  the  only  possible  cases 
of  color-blindness  are  in  people  whose  crystalline  lenses  are  made  like  -a 
simple  bi-convex  lens,  of  one  consistency  throughout.  It  follows  that  such 
a  case  could  not  be  remedied,  except,  possibly,  in  a  rare  case  of  myopia, 
when,  if  the  correcting  lenses  were  made  from  "flint"  glass,  the  negative 
dispersion  would  be  neutralized  by  the  positive  dispersion  of  the  crystalline 
lens  and  the  patient  might  then  be  taught  colors. 

The  rod-and-cone  people  point  to  the  complementary  color  sense  in 
support  of  their  theory  of  the  existence  in  the  retina  of  "three  different  visual 


256  A  SYSTEM  OF  MATURE  MEDICINE 

substances ;"  but  it  is  admitted  that  they  have  been  unable  to  find  which 
color  represents  the  process  of  dissimilation  and  which  represents  the  pro- 
cess of  assimilation.  Rather  an  embarrassing  situation  for  the  theorist. 

In  opposition  to  all  the  old  propositions  I  insist :  First,  that  neither  white 
nor  black  are  colors.  Pigments  are  denominated  white,  black  and  colored; 
but  colors,  per  se,  are  neither  white  nor  black.  White  light  is  a  combination 
of  all  colors.  Second,  instead  of  three  there  are  four  primary  colors,  and  I  will 
prove  this  conclusively  to  every  one  who  will  try  the  experiments  I  will 
propose.  Third,  black  is  simply  the  absence  of  light  or  coloring  matter, 
darkness,  for  example.  Fourth,  diagraming  the  color  proposition  we  have : 


Primary   Colors 


Positive    (+)    /  Red  (Major)  + 

Yellow  (Minor)  — 

Green   (Minor)  — 
Blue   (Major)  + 


That  there  is  nothing  mysterious  about  the  complementary  effects  ex- 
hibited by  white,  black  and  the  colors,  is  easily  proved  by  looking  steadily 
at  the  eye  of  the  accompanying  figure  for  a  minute,  then  interposing  a  sheet 
of  plain,  white  paper,  when  a  white  figure  will  be  seen,  of  the  same  size  and 
form  as  the  black  one. 


THE  COLOR  SENSE  AND  COLOR-BLINDNESS  257 

The  reason  for  this  is  simply  that  the  eyes,  having  accustomed  them- 
selves to  the  black  figure  surrounded  by  the  white  sheet,  noticed  keenly 
the  sudden  change  of  appearance  of  the  space  they  were  fixing  on,  and  the 
space  seemed  whiter  than  the  surrounding  paper.  For  once  white  is  the 
absence  of  darkness.  If  the  same  figure  be  printed  in  white  on  a  black  sheet 
and  the  same  test  made,  interposing  a  sheet  of  white  paper,  the  figure  will 
appear  dark,  because  the  white  figure,  surrounded  by  black,  is  suddenly 
changed  to  a  white  surrounding,  and  the  impression  on  the  brain,  by  way  of 
the  retina,  makes  the  figure  appear  dark;  not  so  dark  as  the  real  picture, 
but  very  distinct.  As  a  matter  of  course  there  is  no  picture  on  the  inter- 
posed paper  in  either  instance.  This  shows  that  it  actually  takes  some  time 
to  transmit  images  from  the  retina  to  the  brain.  Some  people  note  the 
change  quickly.  Others  have  to  work  at  it  to  discover  it  at  all.  Even  those 
known  to  be  color-blind  can  make  this  test,  and  it  proves  there  is  duality 
of  perception,  just  as  there  are  positive  and  negative  poles  to  a  battery.  And, 
remember,  the  nervous  system  is  a  system  of  batteries. 

\Yhen  the  color  sense  is  excited,  in  the  same  manner,  by  any  shade  of 
red,  the  complementary  exhibit  will  be  green,  because  red  is  the  major  or 
-j-  division  of  the  positive  side  of  the  diagram  and  green  is  the  negative 
or  -  -  division  of  the  negative  side  of  the  diagram.  Any  shade  of  yellow 
will  produce  a  complementary  shade  of  blue,  because  yellow  is  the  negative 
or  --  division  of  the  positive  side  of  the  diagram  and  blue  is  the  positive 
or  -j-  division  of  the  -  -  side  of  the  diagram.  In  other  words :  any  one  of 
the  primary  colors  will  produce  its  complementary  color  of  the  opposite 
sign  in  the  opposite  division  of  the  diagram. 

The  proof  of  the  four  primary  colors  and  of  the  entire  theory  is  found 
in  the  physical  construction  of  the  crystalline  lens,  the  aplanatic  lenses  il- 
lustrated on  page  85,  and  by  the  following  physiological  test: 

Take  any  shade  of  any  color  and  try  the  experiment  as  with  the  printed 
figure.  If  the  complementary  color  is  a  shade  of  blue,  yellow  is  the  domi- 
nating color  in  the  object  looked  at;  if  the  complementary  color  is  green, 
red  is  the  dominating  color  in  the  object;  if  the  complementary  color  is  yel- 
low, blue  is  the  dominating  color  in  the  object;  if  the  complementary  color 
is  red,  green  is  the  dominating  color  in  the  object.  Now,  here  is  the 
clincher :  You  will  never  find  a  color  or  shade  of  a  color  that  will  not  return 
one  of  the  four  primary  colors,  thus  proving  there  are  four  primary  colors. 
Of  course  no  color-blind  person  could  get  anything  out  of  this  experiment; 
and  many  who  are  not  color-blind  will  find  it  difficult  at  first.  One  feature 
is  worthy  of  particular  mention :  The  very  dark  shades  of  colors  have  a 
tendency  to  exhibit  as  if  they  were  black;  but  this  makes  the  test  all  the 
more  valuable,  because,  after  some  practice  it  will  be  observed  that  dark 
red  will  have  a  pale  green  complement  and  dark  blue  will  have  a  yellowish 
white  one;  therefore  it  is  easy  to  classify  any  shade  or  color  by  its  com- 
plementary one,  even  when  it  would  be  difficult  to  decide  by  comparisons 
other  than  complementary.  For  example  pale  blue  and  pale  green  appear 
so  nearly  alike  to  most  people  they  could  not  tell  the  difference.  The  com- 
plementary method  will  answer  the  question  promptly  and  decisively:  The 
green  will  exhibit  a  red  complement  and  the  blue  will  exhibit  a  yellow  one. 


258 


A  SYSTEM  OF  MATURE  MEDICINE 


All  sorts  of  colors  can  be  found  in  paper  houses  and  small  bits,  one-half 
inch  square,  are  large  enough  to  make  the  tests  with.  In  testing  cloth  the 
same  sized  pieces  should  be  used  because  of  the  small  field  of  vision  of  the 
eye.  I  stick  a  pin  through  the  middle  of  each  piece,  then  through  the  middle 
of  a  sheet  of  white  letter  paper  and  fix  my  gaze  on  the  head  of  the  pin. 
Nature  does  the  rest. 

If  asked  to  explain  why  these  reactions  produce  the  colors  they  do,  I 
would  say:  On  the  same  principle  already  explained  for  white  and  black, 
coupled  with  the  law  of  colors,  which  is  probably  similar  to  the  law  of 
affinities  in  chemistry.  No  one  has  yet  explained  and  I  doubt  if  any  will  ever 
explain  why  laws  exist.  It  is  enough  for  mankind  to  know  they  do  exist  and 
are  so  constant  they  may  always  be  relied  on  to  respond  when  needed. 


There  have  been  many  tests  devised  for  color-blindness  and  much  has 
been  written  on  the  subject.  It  has  been  declared  a  common  and  dangerous 
condition.  Its  causes  are  charged  to  be  congenital,  tobacco,  liquor  and  all 
sorts  of  possibilities,  all  of  which  are  wrong,  in  view  of  what  has  been 
shown  above,  and  the  writers  have  pretended  to  "cure"  it.  Sentimental  rot 
has  been  indulged,  ad  nauseum.  One  writer  said :  "If  the  person  in  ques- 
tion as  an  applicant  for  employment  even  a  slight  defect  of  the  color  sense 
should  be  sufficient  ground  for  rejection.  If,  however,  we  have  to  deal 
with  an  old  employe,  one  who,  perhaps,  has  discharged  his  duties  in  a  sat- 
isfactory manner,  justice  demands  that  his  interests  be  studied  so  far  as 
is  consistent  with  safety."  It  is  such  nonsense  as  this  that  has  make  rail- 
roads and  other  big  companies  ignore  the  color  test  to  a  large  degree. 

As  a  matter  of  fact  genuine  color- 
blindness is  not  at  all  common.  In  prac- 
tice for  twenty-five  years,  I  have  found 
very  few  cases.  Color  ignorance  is  very 
common.  The  complemental  test  will 
soon  settle  the  matter  in  any  case. 

About  twenty  years  ago  one  of  my 
assistants  devised  a  more  practical  test 
than  any  of  the  much  vaunted  produc- 
tions of  the  "authorities"  because  it  was 
available  by  day  or  night,  while  the  oth- 
ers could  only  be  employed  in  good  day- 
light. It  was  adopted  by  some  of  the 
railroads  because  the  officials  could  make 
tests  themselves  and  settle  the  matter 
without  consulting  an  oculist.  I  matched 
celluloid  colors  with  my  Holmgren  yarns 
and  Mr.  Rumble  constructed  the  mechan- 
ism shown  in  the  cut. 

It  is  all  on  a  card  8%  x  12  inches,  the  two  disks  being  attached  to  the 
back  of  the  card  with  eyelets,  so  they  may  be  rotated.    The  top  disk  contains 


THE  COLOR  SENSE  AND  COLOR-BLINDNESS  259 

one  white  and  three  colored  disks,  light  green,  rose  and  red.  The  lower  one 
carries  three  shades  each  of  green,  rose,  red,  blue,  orange,  purple,  brown 
and  gray.  The  directions  for  use  are  the  same  as  used  for  the  yarns.  On  the 
front  of  the  card  are  two  holes,  one  for  the  small  disk  and  the  other  for 
the  large  one,  so  that  when  the  test  color  is  set  the  others  may  be  rotated 
below  it. 

If  green  be  the  test  color  and  the  patient  cannot  name  it  he  is  either 
color-blind  or  color  ignorant. 

Rotating  the  lower  disk  the  patient  is  asked  to  compare  the  passing  ones 
with  the  color  above  (light  green)  and  to  signify  when  he  sees  one  which 
is  a  shade  of  the  same  color.  Hesitation  in  selecting,  or  the  choice  of  other 
colors  than  green  indicate  deficient  color  sense. 

Turn  the  small  disk  until  rose  is  presented  and  proceed  as  above.  If 
green  shades  are  matched  with  rose  it  is  green-blindness ;  if  blue  be  selected 
it  is  red-blindness. 

The  violet-blind  will  select  blue  in  comparison  with  green  and  red  or 
orange  when  comparing  with  the  rose. 

Full  directions  for  use  are  printed  on  the  front  of  the  apparatus  and  it 
can  be  had  for  about  $1.50.  We  sold  it  to  the  Geneva  Optical  Company 
nearly  twenty  years  ago. 


The  Holmgren  worsted  test  for  color-blindness  consists  in  having  the 
patient  pick  out  from  a  heap  the  skeins  which  appear  to  him  a  shade  of  the 
color  given  him  to  match.  The  yarns  are  placed  on  a  fiat  surface,  covered 
with  a  white  cloth  and  there  must  be  good  daylight.  There  are  three  tests : 

I.  Patient  is  given  a  test  color  of  pure  green  and  told  to  pick  from  the 
heap  all  of  the  skeins  of  that  color  whether  they  be  the  same  shade,  lighter  or 
darker.      Hesitation   is   said    to   indicate   color-blindness.     Those   who   pick 
out  the  correct  shades  readily  are  presumed  to  have  perfect  color  sense  and 
are  not  subjected  to  further  tests. 

II.  A  pale  but  rather  bright,  shade  of  purple  or  rose  is  given  as  the 
sample  and  the  pile  contains  shades  of  that  color  mixed  with  greens,  violets, 
blues    and    other   confusion   colors.     The    red-blind   will   choose   blues    and 
violets ;  the  green-blind  will  select  grey  and  bright  green. 

III.  A  bright  red  is  used  as  the  sample,  and  the  confusion  colors  are 
shades  of  green,  brown,  etc.     The  red-blind  choose  green  and  dark  brown 
The  green-blind  pick  the  bright  green  or  light  ,brown. 

The  Thomson  stick  is  a  most  convenient  arrangement  of  the  Holmgren 
yarns.  It  comprises  about  forty  skeins,  all  numbered  and  arranged  for  com- 
parison with  the  test  colors.  But  no  arrangement  has  been  devised  which 
protects  the  colors  from  becoming  soiled  and  that  renders  the  test  inaccurate. 

The  opinions  of  different  writers  on  the  subject  are  of  passing  interest: 
One  writer  declares  that  there  is  an  advantage  in  being  color-blind  because 
he  knew  "an  engraver  who  could  see  more  distinctly  than  other  people; 
that  when  he  looked  at  a  picture  he  saw  it  as  if  it  were  a  black-and-white 
drawing,  hence  could  distinguish  discords  in  the  lights  and  shades  which  the 
non-color  blind  were  unable  to  do ;  he  could  also  see  farther  in  the  dark 


260  A  SYSTEM  OF  MATURE  MEDICINE 

than  anyone  he  ever  met."  Another  writer  was  requested  by  a  large  printing 
house  to  "test  the  color-sense  of  an  employe  who  had  trouble  with  colors; 
the  gentlemen  presented  the  condition  of  red-blindness  and  was  informed 
he  would  make  a  good  engraver,  when  a  member  of  the  firm  announced 
that  was  his  work  and  he  was  good  at  it." 

Just  why  it  is  necessary  for  one  to  be  color-blind  in  order  to  be  a  good 
engraver  has  not  been  explained,  and,  in  view  of  the  fact  that  I  know  dozens 
of  good  engravers  who  are  not  color-blind,  the  above  appears  like  nonsense 
to  me.  But  it  is  in  line  with  alleged  statistics  of  various  authors  who  pro- 
fess to  have  found  from  5  to  20  per  cent,  of  different  groups,  so  affected. 
They  have,  evidently,  not  considered  color  ignorance  at  all. 

The  whole  proposition  is  made  rather  ludicrous  by  a  report  of  the  British 
Opthalmological  Society,  a  conservative  organization,  in  which  appears  this 
statement:  "Your  committee  becomes  more  and  more  convinced  that  a 
competent  examiner  is  not  made  in  a  day  or  a  month,  and  that  even  with 
large  experience,  much  judgment  and  capacity  are  needful  to  interpret  cor- 
rectly the  acts  of  the  examined." 

The  fact  that  all  such  tests  are  only  possible  in  good  daylight,  and  on 
a  white  cloth,  when  people  who  work  with  colored  lights  on  railroads  do  it 
at  night,  makes  the  test  worse  than  worthless.  And  the  fact  that  of  all  the 
railroad  and  steamship  accidents  which  happen  annually  none  have  been 
traced  to  color-blindness,  makes  the  employment  of  such  tests  needless.  If  a 
man  can't  tell  a  red  lantern  from  a  green  one  or  white  one  he  would  soon 
be  discovered  by  the  office  boy.  The  oracular  writings  of  oculists  on  this 
topic  have  a  tendency  to  make  me  tired. 


CHAPTER  XXXI. 
Physiognomy  and  Craniology  Indicate  Temperament  and  Disposition. 

Ophthalmologists  and  Neurologists  must  not  only  understand  physics, 
anatomy,  physiology,  and  symptomology,  as  they  apply  to  normal  and 
pathological  conditions,  but  it  is  necessary  that  they  understand  the  signifi- 
cance of  appearance,  particularly  of  the  head  and  face,  because  much  depends 
upon  the  temperament  and  disposition  of  patients,  whether  we  work  success- 
fully or  not. 

The  president  of  a  prominent  university  is  reported  to  have  said  some 
years  ago  that  there  are  thirteen  physiognomical  points  of  particular  im- 
portance, and  woe  to  the  person  in  whom  they  are  all  bad.  He  confessed 
that  he  was  deficient  in  ten  of  them,  but  added  that  the  other  three  saved 
him.  I  do  not  believe  him,  because  if  he  had  ten  bad  points  out  of  thirteen, 
he  could  never  have  attained  his  present  position,  and  while  I  do  not  know 
the  man  personally,  I  have  read  many  of  his  utterances,  and  if  he  has  three 
bad  points  out  of  the  thirteen,  he  is  making  a  good  record.  It  is  not  going 
to  be  asserted  here  that  the  points  we  make  are  absolutely  sure,  but  with 
the  qualification  that  one  or  two  very  bad  features  may  be  more  than  offset 
by  a  considerable  development  of  the  others,  it  will  be  found  a  very  practical 
and  safe  proposition,  because  it  is  not  a  theoretical  one,  but  is  based  upon 
careful  study  and  observation  covering  a  period  of  more  than  forty  years. 

The  nose  is  one  of  the  most  conspicuous  parts  of  the  physiognomy,  and 
it  means  a  lot.  Those  with  large  noses  are,  as  a  rule,  good-natured.  If  they 
have  a  crook  on  them,  not  caused  *by  accident,  and  come  to  a  sharp  point,  it 
indicates  a  mean  disposition,  a  vicious  one.  Such  an  individual  would  evict 
a  sick  tenant  from  a  five-dollar-a-month  shack,  if  she  had  not  paid  her  rent, 
or  he  would  corner  the  food  market  and  rob  the  needy,  while  he  would  oc- 
casionally contribute  in  a  conspicuous  manner  to  some  educational  institu- 
tion, or  alleged  aid  society,  composed  of  female  society  snobs,  in  order  to  be- 
come known  as  a  philanthropist.  A  broad,  flat  nose,  with  a  low  bridge  in- 
dicates a  person  of  low  breeding,  one  who  would  be  servile  to  those  over  him, 
and  a  martinet  to  those  under  him.  A  small  nose,  with  a  low  bridge,  really  a 
dimple  where  the  bridge  ought  to  be,  is  usually  on  the  face  of  a  smart-aleck, 
male  or  female;  they  are  people  who  always  demand  eye  glasses  instead  of 
spectacles  when  if  they  undertook  to  wear  eye  glasses,  they  would  have  to 
be  fastened  on  with  cement.  In  the  Neurometer  they  belong  to  the  careless 
and  heedless  class. 

Thin  lips,  with  a  mouth  appearing  like  a  straight  slit  across  the  face, 
which  never  changes  shape,  except  to  draw  a  little  tighter,  in  joy,  grief,  anger, 
or  thought,  are  tyranical.  and  can  only  be  handled  as  patients  by  getting  a 


262  A  SYSTEM  OF  MATURE  MEDICINE 

good  fee  in  advance,  with  a  strict  contract  of  forfeiture,  if  they  do  not  obey; 
they  are  never  careless  and  heedless,  but  are  designing  and  devilish;  they  be- 
long in  class  D  of  the  Neurometer.  A  short  upper  lip  indicates  jealousy,  and 
usually  a  careless,  heedless,  flirty  disposition;  ever  critical  of  others,  yet  al- 
ways doing  things  which,  according  to  their  own  code,  subject  them  to 
criticism;  outside  of  the  features  named  they  are  sometimes  very  agreeable, 
but  they  would  not  be  good  companions  at  any  stage  of  the  game.  The  long 
upper  lip  means  stubbornness ;  as  a  rule,  they  are  good-natured,  but  when 
antagonized  will  fight  until  Hades  freezes;  as  a  rule,  they  are  honest,  but 
when  you  find  a  dishonest  one,  he  is  a  "corker."  He  will  do  anything. 
Thick,  protruding  lips  indicate  sensuality,  unless  decidedly  offset  by  other 
facial  characteristics,  which  is  often  the  case.  A  very  large  mouth  indicates 
quick-temper,  but  when  not  irritated  is  very  agreeable.  Very  small  mouths 
are  usually  quiet,  patient,  people,  but  do  not  try  to  walk  on  them.  A  medium 
mouth  with  fairly  thick  lips,  showing  considerable  red,  is  a  sexual  mouth, 
which  is  entirely  different  from  the  sensual  one.  They  are,  as  a  rule,  very 
lovable  people,  inclined  to  be  careless,  but  amenable  to  reason. 

The  teeth  do  not  indicate  dispositions  so  much  as  they  do  general  condi- 
tions. Substantial,  square  teeth  indicate  a  hardy  constitution,  while  long, 
narrow  ones  are  the  reverse.  Sound  teeth  indicate  a  good  digestion,  and 
reasonable  living  habits,  while  bad  teeth  are  the  reverse. 

A  retreating  chin,  unless  offset  by  very  marked  development  of  good  fea- 
tures, is  a  sign  of  mental  weakness,  in  a  general  way,  although  such  individ- 
uals may  have  special  talents  and  be  financially  successful.  A  protruding 
chin  indicates  egotism,  contrariness,  and  is  often  backed  by  physical  pro- 
portions, which  enable  them  to  make  themselves  very  disagreeable. 

Very  high  cheek  bones  have  been  regarded  as  indicating  a  tuberculous 
tendency,  but  we  have  not  found  that  to  be  true;  they  are  disfiguring  unless 
the  patient  is  fattened  up  until  the  cheeks  round  out,  but  many  very 
prominent  people  have  exhibited  them ;  they  are  usually  smart,  ambitious, 
and  tend  to  professional  pursuits;  as  a  rule,  they  are  reliable,  if  they  have 
agreed  to  be,  but  if  there  is  no  written  or  verbal  contract,  they  will  get  you 
if  they  can,  and  then  laugh  at  you. 

The  eyes  have  been  called  the  windows  of  the  soul,  and  they  are  great 
indicators  of  character.  Black  eyes  are  usually  possessed  by  people  who 
lack  principle;  as  a  rule,  they  are  inclined  to  vanity,  and  very  black  eyes  in- 
dicate extreme  jealousy.  Brown  eyes  indicate  almost  the  reverse.  Blue  eyes 
are  rather  uncertain,  sometimes  they  indicate  absolute  honesty,  thoughtful- 
ness,  carefulness,  and  in  such  cases  they  will  look  straight  at  you,  and  you  will 
feel  that  they  see  clear  through  you ;  you  could  not  deceive  one  of  them, 
and  you  need  not  try.  The  other  class  is  indescribable.  Some  of  them  are 
tricky,  and  many  are  untruthful.  Gray  eyes  indicate  thoughfulness,  self-con- 
trol, good-nature,  fairness  in  judgment  of  others,  and  will  not  tolerate  gossip. 
This  is  also  the  case  with  some  classes  of  blue  eyes.  The  average  pupil  dis- 
tance is,  for  small  people,  2%  inches ;  for  medium-sized  people  2%  inches ; 
for  large  ones  2%  inches.  Any  having  a  narrower  pupil  distance  in  propor- 
tion to  their  size  than  they  should  have,  are  narrow-minded,  although  they 
may  be  very  adept  in  some  particular;  those  who  are  too  wide  between  the 


PHYSIOGNOMICAL  AND  CRANIOLOGICAL  INDICATIONS  363 

eyes  often  have  the  low,  flat  nose,  and  the  peculiar-shaped  upper  lip  of  an 
Ethiopian ;  such  people  are  autocratic,  overbearing,  and,  unless  they  have 
other  marks  which  offset  it,  they  are  good  people  to  let  alone. 

If  the  eye-brows  grow  down  almost  to  the  bridge  of  the  nose  and  form 
an  almost  straight  line  across  the  forehead,  it  indicates  a  peculiar  individual, 
to  say  the  least. 

The  ears  are  conspicuous  indications  not  only  of  characteristics,  but  in 
them  we  have  found  more  exhibits  of  the  degeneration  of  our  race  than  in 
any  other  anatomical  feature.  Any  one  may  look  around  among  the  better 
classes,  that  is,  people  with  faces  and  general  appearance  of  having  been  well- 
raised,  particularly  among  the  older  classes,  and  there  will  be  found  large 
ears,  well-developed,  with  a  good-sized  lobe  hanging  down.  The  younger 
classes,  even  the  children  of  those  referred  to  above,  have  a  notable  lack  of 
lobe,  and  some  have  absolutely  none,  the  lower  part  of  the  ear  being  drawn 
to  a  point  on  the  side  of  the  head,  until  all  it  lacks  is  a  dimple  below  it,  to 
make  it  an  interrogation  mark ;  such  people  are  careless  and  heedless,  satisfied 
to  let  other  people  do  their  thinking,  and  they  are  with  the  crowd,  wherever 
it  goes,  whether  to  church  or  a  "movie."  They  are  almost  insane  over  cab- 
arets and  similar  "excitement."  If  the  ear  is  rounded  out  at  the  bottom, 
but  without  lobe,  it  is  a  better  form,  unless  it  spreads  out  further  than  the 
top,  when  it  indicates  a  rascal,  smart  enough  to  keep  out  of  jail,  but  a  rascal 
nevertheless.  If  the  outer  rim  of  the  ear  lies  too  close  to  the  head,  it  is  bad, 
not  necessarily  a  villain,  but  tending  that  way,  particularly  if  other  phy- 
siognomical features  also  indicate  such  a  disposition;  if  the  rims  stand  out 
too  far,  it  indicates  a  person  who  is  easily  imposed  upon,  good-natured  to 
the  limit.  In  this  connection  it  is  worth  relating  as  an  example,  that  Dr. 
Black  took  photographs  of  the  writer,  and  from  the  negatives  made  up 
pictures,  in  which,  by  printing  one-half  of  the  negative  right  side  up,  then 
turning  the  negative  over,  and  printing  the  other  half,  he  made  pictures  with 
both  sides  of  my  head  alike.  The  one  representing  the  left  side,  compared 
with  that  representing  the  right,  presented  two  different  characteristics.  The 
right  showed  both  ear  rims  close  to  the  head,  the  pupillary  distance  being 
narrow,  while  the  left  showed  a  wider  pupil  distance  and  the  ear  rims  stand- 
ing out  from  the  head.  I  named  them.  The  right  one  I  called  "villain" ;  the 
left  I  called  "easy-mark."  It  had  always  been  a  puzzle  to  me  why  many 
people  tried  to  take  advantage  of  me,  and  it  had  always  been  a  puzzle  to  them 
why  they  did  not  win.  These  pictures  explained  it.  They  came  up  to  me 
from  a  position  in  which  the  left  side  of  my  head  was  illuminated  best,  and 
sized  me  up  from  that  standpoint.  The  good-nature  indicated  by  that  aspect 
seemed  to  warrant  their  going  ahead  with  their  schemes,  and  I  tolerated 
them  clear  up  to  the  limit  angle,  then  the  right  side  of  me  stepped  in  and 
knocked  them  out-.  Thus  I  discovered  the  duality  in  my  temperament  and 
disposition,  which  has  been  a  very  fortunate  one  in  some  respects  at  least. 

A  retreating  forehead  is  usually  accompanied  by  a  correspondingly 
high  point  as  far  back  on  the  crown  as  it  could  be ;  it  means  a  weak  mentality, 
and  an  incorrigible  ego.  A  long,  narrow  head  indicates  a  delicate  constitu- 
tion. A  very  wide,  but  short  head  antero-posteriorly  is  usually  accompanied 


264  A  SYSTEM  OF  MATURE  MEDICINE 

by  a  full  face  and  stock-yard  jowls  with  a  thick,  bovine  neck;  this  is  the 
politician  of  the  lower  order.  He  lives  in  cabarets  much  of  the  time,  and 
is  a  frequenter  of  dives  of  all  sorts,  although  if  he  attains  prominence  political 
ly,  he  may  avoid  them  in  his  home  town.  He  usually  dies  before  he  is  fifty 
from  wrong  habits  of  living. 

There  is  a  normal  development  which  is  between  the  extremes  enu- 
merated above,  and  which  commends  itself  at  once  to  any  observer  because  of 
its  symmetry.  A  very  handsome  man  or  a  very  beautiful  woman  often  pos- 
sesses symmetry,  but  there  is  something  lacking  which  is  difficult  to  describe, 
yet  it  is  not  difficult  for  almost  anyone  to  recognize  a  lack  of  character,  and 
a  tendency  to  travel  on  their  good  looks,  which  they  often  lose  by  accident, 
or  as  they  grow  older.  To  the  skilled  physiognomist  and  craniologist,  such 
people  are  not  attractive  because  of  this  evident  lack  of  character.  Even 
amateurs  are  able  to  recognize  the  good  face  when  they  see  it,  but  those  of  us 
who  have  studied  faces  and  kept  records,  appreciate  character  portrayed  in 
the  face.  To  me  one  of  the  handsomest  women  I  ever  saw  was  a  woman 
about  sixty  years  of  age,  who  arose  in  a  public  meeting  in  Richmond,  Ind., 
and  at  the  first  glance  I  thought  she  was  one  of  the  homeliest  women  I  had 
ever  seen ;  before  she  talked  five  minutes  I  changed  my  opinion  most  radi- 
cally; she  had  a  pleasant  voice,  she  new  what  she  was  talking  about,  she 
was  large  and  dignified,  and  had  character  written  all  over  her  face.  I 
shall  always  remember  Mrs.  Dennis  as  a  beautiful  woman.  I  have  known 
many  others  since,  both  men  and  women,  whose  characters  are  not  only 
stamped  on  their  faces,  but  who  live  and  act  those  characters,  and  it  is  my 
greatest  source  of  satisfaction  to  feel  that  they  are  my  friends,  and  I  am, 
theirs.  It  is  such  people  who  progress ;  who  think ;  who  act ;  who  seek  to 
encourage  others  to  think;  who  accord  others  most  cordially  the  right  to 
differ  from  them ;  who  will  fight  even  a  friend  for  a  principle. 

Neurology  is  cold-blooded  in  its  analysis ;  it  teaches  us  to  study  law 
and  apply  it  to  ourselves  as  well  as  to  others.  It  teaches  us  that  if  we  can 
discover  our  weaknesses,  as  indicated  by  our  physiognomy,  or  craniology,  we 
may,  by  voluntary  effort,  change  those  features  of  our  character,  and  if  we 
do  it  will  change  the  shapes  of  our  heads  and  faces.  I  have  endeavored  to  do 
it,  and  I  know,  and  can  prove  by  photographs,  that  many  remarkable  changes 
in  my  cranium  have  occurred.  I  never  was  a  prize  beauty,  and  never  expect 
to  be  anywhere  in  such  a  class,  but  I  believe  that  any  character  reader  would 
give  me  a  fairly  good  rating  as  to  integrity,  reliability,  stick-to-it-iveness,  and 
appearance  of  health.  I  enjoy  life  and  have  no  fears  of  death,  nor  that  which 
may  follow. 

Every  reader  should  remember  that  no  matter  how  many  points  have  been 
enumerated,  even  the  worst  of  them  may  be  offset  by  the  extra  development 
of  others,  consequently,  while  it  is  not  our  purpose  to  encourage  suspicion, 
we  do  advise  practitioners  to  keep  an  eye  open  for  the  patient  who  has  any 
well-marked  deficiency,  and  in  no  case  classify  finally  until  the  individual  has 
been  put  to  the  test,  because  sometimes  it  may  be  found  that  patients  have 
corrected  some  of  their  bad  characteristics  after  they  matured  physically, 
so  that  the  mark  no  longer  means  what  it  usually  does.  Remember  that 
charity  is  the  greatest  of  virtues  when  conferred  justly. 


CHAPTER  XXXII. 

Some  of  the  Idiosyncrasies  of  "Eminent"  Authors. 

In  their  zeal  to  make  big  books  with  the  hope  of  establishing  reputa- 
tions as  "authorities"  the  earlier  writers  on  all  subjects  undertook  to  explain 
matters  which,  to  them,  were  "phenomena,"  and  they  succeeded  in  making 
themselves  ridiculous  in  many  instances.  Later  scribes  and  pharisees 
imitated  them  and  the  repetitions  have  no  doubt  misled  a  few  students  who 
wasted  a  lot  of  valuable  time  reading  them.  I  say  "a  few"  advisedly,  for  I 
am  reliably  informed  by  a  prominent  medical  book  company  that  only  250 
copies  of  one  of  the  leading  foreign  works,  translated,  were  sold  in  this 
country,  and  the  same  informant  said  the  author  was  so  indignant  he  bought 
the  remainder  of  the  edition  and  destroyed  them.  I  was  one  of  the  two 
hundred  and  fifty.  Probably  one  of  a  very  few  who  have  pondered  the  book. 
I  found  it  more  interesting  negatively  than  positively.  It  is,  evidently,  not 
the  work  of  one  man,  because  the  text  and  the  cuts  do  not  always  fit,  and 
many  of  the  calculations  have  the  ear  marks  of  compilation.  Over  250 
"authors"  are  referred  to  and  quoted,  hence  it  may  be  presumed  to  be  the 
product  of  a  mutual  admiration  society.  However,  it  is  valuable  in  one 
respect,  namely  when  its  weaknesses  are  reviewed  the  story  will  cover  the 
entire  list  of  authors. 

The  first  weakness  is  a  lack  of  consecutiveness,  which  is  always  dis- 
couraging and  confusing  to  students. 

The  second  is  the  mixing  of  essential  facts  with  assumptions  and  as- 
sertions, minus  reasons  therefor. 

The  third  is  the  employment  of  algebraic  equations  instead  of  simple 
figures,  thus  limiting  its  usefulness. 

The  fourth  is  the  elaborate  display  of  "scientific"  opinion  and  the  con- 
spicuous absence  of  common  sense  judgment. 

On  one  page  it  is  stated  positively  that  the  cornea  is  thickest  at  its 
periphery,  hence  is  a  divergent  meniscus,  and  on  another  page  it  gives  the 
first  and  second  principal  focal  distances,  positive,  of  the  cornea.  The  first 
statement  is  true  so  far  as  the  edge  thickness  is  concerned,  but  false  with 
reference  to  the  meniscus  form ;  the  structure  is  simply  thickened  at  its 
edge  for  the  better  attachment  to  the  sclera. 

It  says,  correctly,  that  the  corneal  defects  are  the  commonest  cause  of 
astigmatism,  but  declares,  incorrectly,  that  the  cornea  is  rarely  exempt.  As 
a  matter  of  fact  we  have  found  in  a  practice  covering  twenty-five  years,  that 


A  SYSTEM  OF  MATURE  MEDICINE 


only  about  fifty  per  cent,  of  all  eyes  are  astigmatic  enough  to  demand  cor- 
rection ;  and  as  the  word  "astigmatism"  means  "without  a  point,1'  the  other 
fifty  per  cent,  have  points  or  vision  would  not  be  perfect.  Common  sense 
should  eliminate  hair-splitting  technicalities. 

It  refers  to  "congenital  and  acquired"  astigmatism,  and,  ignoring  the  fact 
that  all  eyes  are  congenitally  defective,  being,  with  the  rest  of  the  body 
below  normal,  hence  must  "acquire"  whatever  errors  are  exhibited  when  the 
eyes  have  ceased  to  grow,  it  proceeds  to  discourse  at  length  about  some- 
thing that  cannot  be  changed,  hence  must  be  corrected. 

It  exploits  "irregular"  astigmatism  and  undertakes,  by  mere  assertion, 
to  show  that  because  we  see  radiating  figures  from  stars  it  proves  we  have 
that  error.  Mere  technicality  again.  As  a  matter  of  practical  fact  we  find 
many  people  without  astigmatism  who  see  distinct  differences  between  the 
radiating  lines  of  the  astigmatic  charts,  and  we  find  as  many  who  have  as 
much  as  1.50  astigmatism  who  see  no  difference  between  those  lines.  Real 
irregular  astigmatism  is  where  one  or  more  meridians  of  the  cornea  are 
corrugated.  In  some  such  instances  we  have  secured  good  vision  with  the 
pin-hole  disk  or  with  the  slotted  disk,  and,  of  course,  prescribed  them. 

It  tells  of  astigmatism  "with"  and  "against"  the  rule,  showing  that  as 
a  rule  the  two  principal  meridians  are  vertical  and  horizontal,  with  the  ver- 
tical exhibiting  the  most  -J-,  but  the  author  makes  himself  ridiculous  by 
saying  "Jews  habitually  exhibit  astigmatism  against  the  rule,"  which  is  not 
true. 

It  tells  how  to  determine  the  amount  of  astigmatism  with  the  ophthal- 
moscope, saying:  "In  the  first  place,  an  emmetropic  observer,  or  an  observer 
provided  with  his  correcting  glass,  will  never  be  able  to  see  distinctly  all 
parts  of  the  ophthalmoscopic  image  at  once,  because  he  is  thus  adapted  to 
only  one  or  the  other  meridian  at  a  time,  but  never  for  both  simultaneously." 
We  doubt  if  the  author  ever  used  an  ophthalmoscope,  because,  if  he  did, 
he  would  have  discovered  that  the  observer  uses  a  lot  of  accommodation ; 
and  had  he  known  anything  of  physics  he  would  have  known  that  3.00  units 
of  astigmatism  would  only  throw  one  meridian  out  of  focus  three  fourths 
of  a  millimeter,  and  any  observer  would  be  able  to  adjust  his  eye  to  either 
meridian  at  will  and  get  a  good  view  of  each.  Only  very  ignorant  or  very 
unveracious  people  ever  pretend  to  fit  eyes  with  the  ophthalmoscope. 

It  attributes  astigmatism  to  "asymmetry  of  the  cranium"  as  "a  probable 
primary  cause."  If  the  claim  has  any  foundation  in  physics  the  author 
neglected  to  favor  us  with  it,  and  if  it  has  foundation  in  fact  nearly  all  of 
us  should  have  "irregular"  astigmatism.  It  would  be  just  as  reasonable  to 
say  deficient  nose  bridges  are  the  cause. 

It  says:  "The  crystalline  often  partakes  of  the  astigmatism,  sometimes 
in  a  passive,  at  other  times  in  an  active  way.  The  former  case  is  met  with 
when  the  globe  of  the  eye,  or  at  least  the  anterior  portion  of  it,  is,  as  it  were, 
flattened  in  one  meridian.  Then  the  crystalline,  compressed,  so  to  say,  in 
a  corresponding  meridian,  approaches  the  likewise  compressed  form  of  the 
cornea  and  the  static  crystalline  astigmatism,  adds  itself  to  that  of  the 
cornea."  That  is  a  "pipe  dream"  and  needs  no  comment,  except,  suppose 
there  be  such  cases,  it  doesn't  tell  how  to  fix  them. 


IDIOSYNCRASIES  OF  "EMINENT"  AUTHORS  2G7 

It  tells  of  "hereditary"  astigmatism  when  it  is  a  well-known  fact  that 
parents  without  arms  or  otherwise  deformed  rarely  if  ever  had  children 
similarly  deformed.  My  own  two  boys  were  emmetropes,  although  both 
their  mother  and  myself  are  highly  hyperopic,  and  I  am  astigmatic. 

It  confesses  the  author's  "knowledge  as  regards  muscular  asthenopia 
and  insufficiency  of  convergence  is  still  in  its  infancy,"  and  then  proceeds 
with  an  alleged  explanation  saying:  "Insufficiency  of  convergence  is  quite 
a  wide-spread  affection,  and  a  frequent  cause  of  asthenopia."  But  there  is 
no  explanation  of  how  it  causes  it.  As  a  matter  of  obvious  fact  it  does  not 
cause  it.  The  reason  is  that  so-called  muscular  asthenopia  and  insufficiency 
are  identical,  hence,  one  could  not  cause  the  other.  Both  are  the  result  of 
exhaustion  of  the  nerve  supply  from  over-taxation  or  deficient  development. 
Even  when  there  is  nervous  spasm  exhibiting  in  one  set  of  muscles,  until 
there  is  imbalance  it  is  because  there  is  insufficient  nerve  supply  to  do  the 
work  normally.  It  is  evident  in  all  of  their  works  that  orthodox  oculists 
are  only  physicians  by  virtue  of  having  received  the  degree  M.  D.,  because 
they  ignore  so  much  that  they  could  know  if  they  studied  the  nervous  system 
broadly.  If  they  knew  anatomy  and  physiology  as  they  should  they  would 
see  how  criminal  it  is  to  cut  muscles.  If  they  knew  physics  they  would  see 
that  the  employment  of  prisms  is  foolish  on  the  part  of  the  doctor  and  harm- 
ful to  patients. 

The  book  says  that  "at  about  the  fifty-fifth  year  emmetropes  begin  to 
grow  hyperopic,  hyperopes  become  more  so,  and  myopes  become  less  myopic, 
the  change  by  the  eightieth  year  being  as  much  as  2.25  diopters."  The  only 
excuse  for  such  a  statement  is  that  the  writers  did  not  know  much  about 
the  nervous  system  and  its  persistence  in  acting  on  the  accommodation,  and 
this  assumption  is  supported  by  the  fact  that  nerves  and  nervous  energy 
are  scarcely  mentioned  in  the  work.  The  facts  are  that  an  emmetrope  re- 
mains an  emmetrope ;  the  cases  they  found  developing  hyperopia  were 
hyperopic  all  the  time,  but  it  was  latent  until  made  manifest  by  presbyopia. 
The  same  is  true  of  the  other  two  classes  of  cases,  the  hyperope  did  not 
manifest  all  of  his  hyperopia  until  (presbyopia  exposed  it,  and  the  myope 
manifested  more  myopia  than  he  really  had  until  presbyopia  suppressed  his 
accommodation.  The  reason  the  latter  develops  spasm  of  accommodation  is 
the  relationship  between  convergence  and  accommodation,  hence  his  work- 
ing distance  in  his  earlier  life  is  much  nearer  than  normal.  At  the  presbyopic 
age  his  working  point  recedes,  and  they  inferred  it  was  reduced  myopia. 
Such  people  never  see  at  a  distance  of  six  meters  or  farther  any  better 
than  they  did  before  the  presbyopic  age.  Young  myopes  with  very  near 
working  points  can  be  enabled  to  work  farther  away  by  putting  on  prisms, 
bases  in,  4  degrees  for  each  unit  of  myopia.  A  hyperope  can  be  made 
artificially  myopic  and  the  same  experiment  tried  with  success. 

They  report  "idiopathic  tonic  spasm  of  accommodation"  in  two  cases  of 
hyperopia  under  the  heading  "painful  accommodation"  and  say:  "A  cure 
was  brought  about  by  a  course  of  atropine  continued  several  months." 
We  have  had  hundreds  of  such  cases,  but  we  corrected  the  hyperopia,  re- 
quired rest,  baths  and  other  rational  care,  and  all  inconvenience  passed 
away  without  making  the  patients  artificially  presbyopic. 


268  A  SYSTEM  OF  MATURE  MEDICINE 

They  say  the  inferior  oblique  muscles'  function  is  to  pull  in  and  down 
on  the  posterior  poles  of  the  eyes,  thus  directing  the  fronts  out  and  upward ; 
that  the  function  of  the  superior  obliques  is  to  pull  in  and  up  on  the  posterior 
poles  directing  the  fronts  down  and  out.  This  is  false  for  two  reasons, 
first,  the  muscles  do  no  such  thing,  because,  if  one  pulled  the  other  would 
have  to  push  in  looking  obliquely  sidewise  with  both  eyes;  second  the 
superior  and  inferior  recti  pull  the  eyes  upward  and  downward  in  front, 
and  the  right  internus  and  left  externus  turn  the  eye  to  the  left,  and  the 
left  internus  and  right  externus  pull  to  the  right;  thus  the  axes  can  be 
directed  to  the  right  or  left  in  any  plane,  while  if  their  story  was  true,  oblique 
movement  could  only  be  had  in  the  45th  and  135th  meridians.  The  true 
function  of  the  obliques  is  to  prevent  the  eyes  from  rolling  in  their  optical 
axes.  The  inferior  obliques  have  innervation  from  the  third  and  the  superior 
obliques  from  the  fourth  nerves,  hence  they  are  antagonists  for  a  purpose, 
just  as  the  externi,  sixth  nerves,  and  interni,  third  nerves,  are  antagonists. 
The  superior  and  inferior  recti  are  antagonists,  but  not  in  the  same  sense 
the  others  are ;  they  are  supplied  from  the  third  nerves  and  work  coordinately 
to  hold  the  eyes  on  the  horizontal  plane. 

They  advise  against  the  correction  of  anisometropia  because  "patients 
will  not  tolerate  it."  We  have  been  correcting  all  'such  cases  for  twenty- 
five  years.  Of  course,  there  is  an  unpleasant  period  of  readjustment  of  the 
nervous  system,  but  it  is  a  mechanical  proposition  and  we  knew  it  would 
work  out  successfully,  which  was  invariably  the  case. 

The  book  says :  "Within  a  period  of  three  years,  ten  per  cent,  of  the 
emmetropes  in  Harvard  College  became  myopic.  In  a  Breslau  gymnasium 
of  138  persons,  84  were  emmetropes  and  54  myopes;  at  the  end  of  eighteen 
months  70  remained  emmetropes  and  14  had  become  myopic  from  0.80  to 
2.00  -diopters."  I  will  wager  a  pretty  prize  that  is  a  colossal  mistake.  Some 
of  the  so-called  emmetropes  wore  out  their  tonic  spasm  and  exhibited  their 
hyperopia;  others  developed  spasm  and  manifested  false  myopia.  I  have 
examined  at  least  20,000  people,  over  3,000  students  in  my  school,  and  I 
have  not  found  as  much  as  one  per  cent,  emmetropic.  Such  a  difference  is 
not  possible,  and  they  must  be  wrong  because  I  proved  hyperopia  in  ninety 
per  cent,  of  the  cases  and  myopia  in  more  than  nine  per  cent. 

The  book  figures  the  dioptric  system  of  the  eye  on  a  basis  of  the  length 
of  the  antero-posterior  axis  instead  of  from  the  optical  center  or  nodal 
points;  and  by  their  figures  the  emmetropic  eye  has  43.81  diopters,  when, 
measured  from  the  optical  center,  it  has  63  diopters  power.  The  books  all 
manage  to  evade  locating  the  optical  center,  hence  have  to  figure  from  the 
corneal  summit.  They  give  tables  of  the  various  lengths  of  eyes  having 
"axial"  hyperopia  and  myopia.  Why  not  simply  say  that  the  normal  eye 
has  a  principal  focal  length  from  the  optical  center  of  15.872  millimeters, 
which,  divided  into  1,000,  gives  63.000  diopters ;  one  half  diopter  of  hyperopia 
would  mean  a  power  of  62.50,  which  divided  into  1,000  gives  16  mm.  as  the 
focal  Distance;  or  one  half  diopter  of  myopia  would  mean  63.50  power  and 
that  divided  into  1,000  gives  15.748  mm.  focal  length.  Tables  take  up  too 
much  room  and  do  not  teach  principles. 

The   book   says :     "The   accommodation   is   never   so   much    at   rest   as 


IDIOSYNCRASIES  OF  "EMINENT"  AUTHORS 


when  the  operator  is  using  the  ophthalmoscope,  excepting  when  under  a 
cycloplegic."  It  also  says  :  "The  operator  must  learn  to  control  his  own 
accommodation.  It  is  very  easy."  Both  statements  are  unqualifiedly  false, 
as  anyone  may  prove  easily  by  a  few  trials. 

It  says  :  "Cross-eyes  cannot  be  straightened  without  operation,  except 
in  very  young  children,  and  even  then  they  will  always  have  to  wear  glasses 
thereafter,  especially  for  reading."  Nothing  more  consummately  idiotic  ever 
appeared  in  a  book.  And  it  was  written  after  I  had  supplied  the  authors 
with  abundant  evidence  that  age  makes  little  difference  and  what  there  is 
favors  the  older  ones.  After  presbyopia  arrives,  when  there  is  no  longer 
any  effort  to  overcome  hyperopia  by  accommodation,  cross-eyes  straighten 
themselves.  But  what  is  the  use  in  waiting  when  the  full  correction  of  the 
hyperopia  does  the  work,  with  some  skillful  assistance  by  the  ophthalmolo- 
gist in  toning  up  the  general  nervous  system.  The  idea  that  children  should 
only  wear  the  correcting  glasses  when  at  close  work  is  positively  silly. 
Everyone's  eyes  converge  then.  I  have  shown  elsewhere  in  this  book,  as 
well  as  I  can  tell  it  in  a  book,  how  to  do  the  work  without  operation,  and 
why  operations  are  foolish.  The  "authorities"  do  not  appear  to  know 
muscles  depend  on  nerve  supply  for  the  performance  of  their  work. 

It  says  :  "Of  more  importance  than  the  glasses  for  distance  are  those 
for  working  points.  A  priori  it  would  seem  best  to  have  the  hyperope  start 
at  once  by  wearing  that  glass  which  corrects  the  total  hyperopia  and  so 
convert  him  into  an  emmetrope  ;  but  in  that  case  he  would  soon  quite  forget 
altogether  how  to  correct  his  hyperopia  by  his  accommodation  in  case  of 
necessity.  Should  he  then  be  accidentally  deprived  of  'his  glasses  he  would 
be  thrown  into  a  very  embarrassing  position,  for  he  could  no  longer  see 
clearly  with  his  naked  eye.  We  therefore  confine  ourselves  to  correcting 
the  hyperopia  by  glasses  only  as  far  as  is  required  to  relieve  the  asthenopia. 
For  this  purpose  it  is  generally  sufficient  to  give  a  glass  which  is  somewhat 
stronger  than  the  'manifest  hyperopia."  If  we  searched  a  month  we  could 
not  find  a  more  idiotic  assertion  in  a  book  than  those  contained  in  the  above. 
The  author's  "a  priori"  conclusion  was  correct;  but  he  made  it  to  repudiate. 
He  might,  just  as  intelligently,  have  condemned  the  general  public  as  in- 
decent for  going  about  with  naked  eyes.  The  childish  idea  that  if  a  person's 
eyes  be  made  normal  he  would  "quite  forget  altogether"  how  to  correct  his 
eyes  by  accommodation,  is  worthy  of  the  "scientific"  section  of  an  "optom- 
etry"  society. 

Then  the  same  writer  goes  on  to  say:  "We  correct  the  total  amount  of 
myopia  found  under  a  cycloplegic."  Here  is  proof  the  fellow  didn't  under- 
stand himself  when  he  wrote  the  other  paragraph.  He  proposes  to  under- 
correct  hyperopes,  who  have  an  over-developed  power  of  accommodation,  but 
have  overtaxed  it  until  it  is  presbyopic,  "lest  they  forget  how  to  use  it,"  and 
he  puts  full  corrections  on  myopes  who  have  never  never  learned  to  use  their 
accommodation  up  to  normal  ;  thus  he  would  put  both  in  conditions  re- 
quiring maximum  effort  with  minimum  nerve  supply. 

The  book  advises  prism  treatment  for  heterophoria,  but  adds  :  "When 
everything  else  has  been  tried  and  failed,  an  operation  is  indicated."  Thus 


270  A  SYSTEM  OF  MATURE  MEDICINE 

the  author  proves  he  is  an  experimenter.  The  facts  are :  First,  a  muscle 
is  only  the  medium  through  which  nerve  force  is  applied;  hence,  in  hetero- 
phoria,  or  heterotropia,  when  there  is  deviation,  the  fault  is  in  the  nerve 
supply  and  demand,  not  in  the  muscles.  In  the  test  for  heterophoria,  in  which 
the  eyes  are  thrown  out  of  gear  so  they  "list"  and  expose  the  condition  of 
the  nervous  system  to  the  intelligent  operator,  a  prism  is  used  base  out  to 
find  the  relative  weakness  of  the  nerve  supply,  and  base  in  to  ascertain  the 
relative  amount  of  spasm.  The  cause  of  either  is  the  effort  to  overcome 
hyperopia,  or  from  an  effort  at  coordination  in  myopia ;  and  when  the  test 
is  removed  the  controlling  centers  in  the  brain  act  automatically  to  line  the 
eyes  up  so  they  see  singly;  therefore  to  use  prisms  or  operate  on  deviating 
tendencies  which  exhibit  only  under  the  test  is  wrong  for  two  reasons :  First 
the  prisms  would  cause  extra  nerve  strain  and  operation,  not  being  indicated, 
is  both  needless  and  dangerous;  second,  the  cause  of  the  exhibit  is  not  re- 
moved unless  full  correction  for  existing  hyperopia  is  given  and  if  that  is 
done  no  other  treatment  is  needed.  The  same  applies  to  heterotropia.  We 
have  been  treating  all  such  cases  successfully  for  twenty-five  years. 

Following  Bonders  and  other  old-timers,  who  were  not  aware  of  the 
fact  that  many  of  the  so-called  emmetropes  of  their  day  were  hyperopes 
of  low  degree  and  concealed  the  defect  by  accommodation  until  presbyopia 
arrived,  the  modern  writers  insist  that  "emmetropes  become  hyperopic  in 
old  age,  and  myopes  become  emmetropic  or  even  hyperopic."  This  is  a 
false  doctrine  due  to  the  fact  that  they  depended  on  atropine  to  paralyze  the 
accommodation  completely,  and  permit  the  total  error  to  become  manifest 
at  once,  when,  if  they  had  followed  the  rational  plan  of  taking  three  months 
or  more  to  find  the  total  error  in  hyperopia  and  to  avoid  overcorrecting 
myopia,  thus  creating  artificial  hyperopia  and  nerve  strain  through  the  eyes, 
they  would  never  have  fallen  into  such  an  egregious  mistake. 

I  could  go  on  and  fill  fifty  pages  with  proofs  of  their  idiosyncrasies,  but 
these  are  sufficient  to  set  the  readers  of  this  book  thinking,  and  if  they  will 
study  physical  optics,  then  anatomy  and  physiology,  they  will  be  able  to  de- 
tect false  statements  by  force  of  their  own  logic. 


CHAPTER  XXXIII. 
Idiosyncrasies  Which  Exhibit  in  People  of  Various  Professions  and  Trades. 

The  special  definition  of  idiosyncrasy  in  medical  dictionaries  is:  "Any 
special  or  peculiar  characteristic,  or  temperament,  by  which  a  person  differs 
from  other  persons.  A  peculiarity  of  constitution  that  makes  an  individual 
react  differently,  to  drugs,  or  other  influences,  from  most  persons." 

We  have  nothing  to  do  practically  with  the  first  section  of  that  defini- 
tion, because  we  do  not  give  drugs.  When  we  find  patients  who  declare 
that  they  cannot  eat  certain  things  without  exhibiting  peculiar  results,  we 
know  that  is  a  symptom  of  physiological  disorder,  and  we  proceed  to  re- 
arrange the  whole  system,  when,  after  a  few  days  under  our  methods,  a 
patient  will  eat  anything  that  is  eatable. 

With  reference  to  the  second  portion  of  the  definition,  we  have  a  great 
deal  to  do,  so  much  that  we  have  made  it  a  special  study,  while  other  doctors 
have  neglected  it.  These  exhibits  mean  very  much  to  us,  and  one  of  our 
students,  of  Jewish  persuasion,  hit  it  off  nicely  with  his  pronunciation,  "idio- 
syn-crazies."  It  has  already  been  stated  that  a  disordered  physiology  means 
a  disordered  mentality,  and  these  "idio-syn-crazies"  afford  us  an  opportunity 
to  employ,  tactfully,  a  reasonable  amount  of  ridicule  and  other  effective 
means  in  controlling  patients. 

We  have  observed  that  of  all  patients  who  come  to  us,  the  very  best 
ones  are  men  whose  occupations  are  such  that  they  are  dealing  with  physical 
facts,  problems  that  can  be  worked  out  to  a  certainty,  and  women  who  are 
dealing  with  household  affairs,  raising  a  family,  are  so  situated  so  that  they 
have  to  use  their  reasoning  powers  to  make  finances  go  as  far  as  pos- 
sible, and  develop  their  children  physically  and  mentally.  Such  people  are 
amenable  to  reason,  and  do  exactly  what  they  are  told.  They  ask  intelligent 
questions  always. 

The  worst  cases  we  get  are  those  men  and  women  whose  occupations 
are  such  that  they  do  not  have  to  calculate,  but  merely  assert.  These  in- 
clude clergymen  and  their  wives,  doctors  and  their  wives,  school-teachers 
and  lawyers,  the  latter  are  practically  all  "statute  lawyers,"  without  any 
knowledge  of  principles  of  law,  such  fellows  as  go  before  a  jury  and  howl 
like  Comanche  Indians,  and  seeking  to  intimidate  witnesses,  they  practice 
all  sorts  of  trickery,  and  sell  out  their  clients  to  the  highest  bidder. 

I  want  to  put  particular  emphasis  on  the  difference  between  the  person 
who  sits  down  and  makes  a  calculation,  which  must  come  out  like  book- 
keeping, and  the  one  who  is  educated  in  mystical  lore,  who  is  accustomed  to 
teaching  people  whose  mental  development  is  so  weak  they  allow  him  to  do 
their  thinking  for  them.  No  person  whose  profession  is  teaching  by  bald 


272  A  'SYSTEM  OF  MATURE  MEDICINE 

assertion  can  develop  his  own  mind  or  those  of  others.  Give  me  a  good 
chess  player  for  a  patient,  if  you  please.  I  have  become  so  thoroughly  con- 
vinced of  the  necessity  for  encouraging  people  to  develop  their  own  capacity 
for  thought  that  I  teach  in  my  school-room,  in  my  paper,  and  in  every  other 
way  possible,  that  everyone  should  learn  the  game  of  chess.  It  is  compara- 
tively easy  to  master  the  principles,  and  the  opportunity  for  developing  skill 
is  only  measured  by  the  capacity  of  the  individual.  It  is  an  honest  game; 
the  person  who  gets  beat  really  wins  the  game,  because  he  sees  how  his 
opponent  did  it.  I  learned  more  about  chess  by  working  on  puzzles  than  any 
other  way,  and  almost  anyone  who  wants  to  learn  can  find  somebody  who 
will  give  a  few  lessons  on  the  movements ;  then  the  puzzles  enable  one  to 
play  solitaire.  The  advantage  of  puzzles  is  that  the  individual  plays  both 
sides  of  the  game,  and  it  teaches  him  principles  which  ought  to  apply  to  the 
consideration  of  every  subject:  It  forces  consideration  of  opinions  antago- 
nistic to  our  own ;  it  helps  us  in  forming  plans  and  developing  methods  of 
procedure,  because  it  enables  us  to  consider  possible  obstacles ;  it  teaches, 
more  than  anything  else,  the  obvious  foolishness  of  trying  to  gain  a  point  by 
a  trick. 

In  dealing  with  the  public,  as  a  doctor  of  any  sort,  it  is  absolutely  neces- 
sary to  study  mentalities,  and  in  order  to  be  able  to  do  this  one  must  read 
in  great  variety.  He  must  know  a  little  about  all  sorts  of  business,  in  order 
to  be  able  to  use  illustrations  which  will  render  misunderstandings  impos- 
sible, and  one  thing  the  practitioner  learns  first  is,  that  with  most  people 
his  instructions  should  be  put  in  writing. 

To  illustrate  how  easy  it  is  to  misunderstand,  an  experience  I  had  with 
a  prominent  attorney,  now  a  judge,  is  worth  relating:  At  the  time  I  knew 
him  first  he  was  a  corporation  attorney  drawing  $20,000  a  year;  hence  I 
regarded  him  as  a  man  of  capacity,  and  I  suppose  he  is,  in  a  way,  but  that 
he  did  not  know  anything  about  himself  is  proved  by  the  incident.  His 
wife  brought  him  to  me  as  a  patient,  and  he  declared  there  was  nothing  the 
matter  with  him  that  he  knew  of,  but  that  his  wife  was  generally  right,  and 
he  would  do  whatever  I  said,  and  he  did ;  but  in  the  course  of  the  examination 
I  asked  him  if  he  was  constipated;  he  said  "No."  Then  I  asked  him  how 
often  his  bowels  moved.  He  replied  "Once  a  week."  I  prescribed  for  him, 
and  at  the  end  of  three  weeks  he  reported  feeling  fine.  Said  he  would  not 
have  come  except  for  two  reasons,  one  that  he  had  promised  to  report,  and 
the  other  was  that  he  had  a  diarrhoea  that  was  worrying  him  a  little  mentally, 
although  it  did  not  seem  to  hurt  him  physically.  I  asked  him  how  frequently 
his  bowels  moved,  and  he  said  "Once  a  day."  -  I  laughed  and  told  him  to 
get  out  of  the  office,  and  go  home  and  read  a  physiology  a  few  nights,  or  ask 
some  ordinary  citizen  to  define  diarrhoea  for  him.  But  think  of  such  a  man 
settling  affairs  generally,  in  the  capacity  of  a  judge. 

One  of  my  patients  was  a  minister  who  came  to  me  because  of  my 
name.  He  said  that  as  a  boy  and  young  man  he  had  a  school-teacher  of  that 
name  who  was  one  of  the  nicest  men  he  ever  knew,  and  he  thought,  when  he 
saw  my  sign,  that  if  he  could  strike  another  one  as  good,  he  would  have  his 
eyes  looked  after.  Inquiry  developed  the  fact  that  his  school-teacher  had 


IDIOSYNCRASIES,  PROFESSIONAL  AND  TRADE  273 

been  my  father,  hence  I  had  his  confidence,  and  he  not  only  had  me  take 
care  of  him,  but  he  brought  his  wife  to  me.  I  gave  them  full  correction, 
which,  of  course,  inconvenienced  them  at  first,  as  I  explained  to  them  it  would, 
and  they  got  along  very  nicely ;  but  after  a  few  weeks  they  came  to  me  with 
the  complaint  that  the  reflections  from  their  glasses  worried  them  greatly, 
and  demanded  that  I  do  something  to  prevent  it.  Now,  this  man  was  sup- 
posedly versed  in  the  laws  of  God,  and  yet  he  did  not  know  the  laws  of  re- 
flection, because  the  bible  does  not  teach  such  things.  I  told  him  I  could  see 
only  one  way  out  of  his  dilemma,  and  that  was  that  the  next  time  he  caught 
God  in  the  closet,  roast  him  for  making  the  laws  of  reflection.  Of  course 
he  was  shocked,  and  then  I  told  him  that  on  second  thought,  I  would  rather 
he  would  not  roast  God,  'because  He  might  get  angry,  and  extinguish  the 
laws  of  reflection,  in  which  case  he  would  not  be  able  to  find  his  glasses,  if 
he  lost  them,  nor  would  he  be  able  to  see  his  wife,  or  his  congregation,  or 
anything  else  that  is  not  luminous.  Then  I  explained  to  him  that  the  alleged 
creator  he  worshiped,  and  whose  word  he  reverenced  was  either  ignorant 
of  the  laws  of  creation,  or  was  criminally  negligent  in  not  giving  them  for  the 
benefit  of  his  children  in  his  written  word.  He  saw  the  point,  and,  strange 
to  relate,  he  followed  instructions,  when,  of  course,  the  inconvenience  dis- 
appeared after  awhile,  illustrating  the  capacity  for  adaptation,  which  Nature 
has  provided  in  all  of  us. 

It  requires  not  only  preparation,  but  great  patience,  to  handle  cases  as 
they  come,  because  we  get  so  many  who  are  wise  in  their  own  conceit.  One 
class  comes  loaded  to  the  brim  with  polysyllabic  words  relating  to  their 
symptoms,  as  they  have  gathered  them  from  doctors  who  have  treated  them, 
or  from  other  people,  laymen,  who  have  diagnosed  their  cases  on  the  strength 
of  vicarious  information  gathered  promiscuously  from  reading  patent  medi- 
cine almanacs,  or  the  "health''  rot  printed  in  newspapers.  They  rarely  ever 
use  the  big  words  correctly,  but  often  disclose  by  their  general  report  the 
fact  that  some  doctor  has  been  filling  them  full  of  gush  about  something 
of  which  he  knew  nothing.  I  usually  let  them  run  down  like  a  clock,  and  then 
I  ask  them  to  tell  me  where  they  heard  it,  and  give  me  some  other  particulars 
with  which  they  are  familiar,  and  advise  them  against  trying  to  bluff  their 
way  anywhere. 

Another  class  of  cases  comes  with  an  injured  air  and  a  general  roast  for 
all  doctors,  as  if  that  would  intimidate  us,  and  cause  us  to  do  good  work 
and  do  it  cheaply.  Our  method  is  to  let  them  talk  a  little  while,  and  then 
ask:  "What  did  I  ever  do  to  you?"  This  is  a  stumper.  They  hesitate,  and 
it  is  an  old  axiom  "He  who  hesitates  is  lost."  I  follow  it  up  with :  "Now 
cut  that  stuff  all  out,  I  do  not  tolerate  it.  If  we  do  business,  it  will  be  done 
my  way,  and  you  will  not  be  imposed  on,  because  it  is  not  a  part  of 
Nature's  plan  nor  ours  to  make  our  patients  uncomfortable,  except  possibly 
the  practice  of  a  little  self-denial.  The  law  works  if  you  will  let  it,  and  it  is 
to  our  interest,  both  of  us.  that  I  do  the  best  I  can,  and  you  do  the  best  you 
can.  If  you  are  willing  to  proceed  on  that  basis,  and  are  willing  to  pay  me 
a  fee  in  advance  as  a  guarantee  you  will  keep  your  part  of  the  agreement; 
all  will  be  well.  I  have  every  reason  to  do  the  best  I  can,  because  I  want 


274  A  SYSTEM  OF  MATURE  MEDICINE 

to  keep  my  record  clear.  You  have  every  reason  to  do  the  best  you  can 
because  you  want  to  get  well ;  but,  inasmuch  as  your  mentality  is  probably 
as  much  deranged  as  your  physiology,  we  have  to  demand  a  guarantee,  in 
order  to  be  sure  you  will  keep  faithful.  We  have  found  that  people  will  do 
for  dollars  much  more  than  they  will  for  ethical  reasons."  This  procedure 
was  forced  upon  us  by  reason  of  statistical  facts.  A  great  many  people 
have  reported  at  our  college  as  students  because  of  the  benefits  they  received 
from  our  graduates,  and  almost  invariably  they  tell  us  that  had  they  not  paid 
their  fee  in  advance,  they  would  have  quit  the  doctor  after  a  few  weeks,  be- 
cause he  would  not  allow  them  to  eat  everything  they  wanted,  and  that  he 
placed  other  restrictions  upon  them  which  seemed  to  be  hardships ;  but,  hav- 
ing paid  a  good  fee  they  could  not  afford  to  lose  it,  so  they  did  follow  in- 
structions, practiced  what  seemed  at  the  time  hardships,  and  the  results 
they  got  were  what  brought  them  to  school  to  take  the  course. 

When  anyone  tells  me  he  cannot  quit  drinking,  or  eating  pie,  or  smoking 
cigarettes,  or  any  other  habit  which  I  find  is  working  injury  to  him,  I  put 
it  down  as  an  "idio-syn-crazy,"  and  explain  that  so  long  ago  as  the  days  of 
King  Solomon,  the  power  of  habit  was  recognized,  so  that  Solomon  said: 
"He  that  conquereth  himself  is  greater  than  he  that  conquereth  a  city." 
Now,  somebody  is  going  to  criticise  me  for  quoting  the  bible,  when  I  have 
denounced  it  as  a  spurious  word  of  a  spurious  god.  That  shows  up  their 
"idio-syn-crazy,"  because  a  truth  is  a  truth,  even  if  it  is  uttered  by  a  fool 
or  a  criminal.  There  are  many  good  things  in  the  bible  but  there  is  much 
that  is  obviously  false,  a  tremendous  amount  that  is  vile ;  yet  I  love  it,  be- 
cause I  can,  by  reading  it  intelligently,  separate  the  rational  from  the  false 
and  irrational.  Those  who  read  it  with  a  credulity  drilled  into  them  from 
childhood  are  liable  to  be  terribly  misled,  but  that  is  their  own  fault  or  the 
fault  of  their  teachers. 

A  class  which  is  very  trying  comprises  those  who  have  a  smattering  of 
learning.  They  hold  certificates  as  teachers,  and  they  have  taught  in  one 
grade,  handicapped  by  board-of-education  regulations,  until  they  have  lost 
their  capacity  for  reasoning,  yet  because  they  arc  school-teachers,  they  think 
they  are  on  an  equality  with  every  other  teacher;  hence  capable  of  discussing, 
or  even  arguing  subjects  of  which  they  really  know  nothing.  They  are  filled 
with  a  foolish  pride  which  makes  them  feel  that  to  admit  they  do  not  know 
all  about  everything  would  be  a  confession  of  utter  ignorance.  Some  of 
that  class  have  attended  our  school,  and  it  was  very  rarely  that  they  were  any- 
where near  the  head  of  their  classes,  because  they  came  with  a  feeling  of 
superiority  over  those  who  have  not  taught  school,  and  when  they  found 
they  were  up  against  the  real  thing,  and  others  who  had  nothing  more  than 
a  common  school  education,  and  some  business  experience,  ran  clear  away 
from  them,  they  got  discouraged,  and  constantly  apologized  and  explained ; 
some  of  them  even  argued  that  a  perpendicular  is  straight  up  and  down,  when 
we  told  them  that  vertical  is  the  word  to  use,  that  vertical  is  the  opposite 
to  horizontal,  and  that  a  perpendicular  may  be  vertical,  horizontal  or  ob- 
lique. One  student  who  had  been  a  teacher  took  me  to  task  in  the  class 


IDIOSYNCRASIES,  PROFESSIONAL  AND  TRADE  275 

room  one  day  because,  while  dictating  an  advertisement  for  them,  I  said: 
"If  you  are  well  and  want  to  get  weller,  you  must  do"  thus  and  so.  He 
told  me  there  was  no  such  word  as  "weller."  I  replied:  "Yes,  there  is;  I 
just  made  it."  He  leaned  back  in  his  chair  and  almost  collapsed,  but  it 
suddenly  dawned  on  him  that  all  words  were  made  at  one  time  or  another; 
he  laughed  heartily,  and  the  incident  appeared  to  loosen  the  bonds  which 
held  him,  he  discovered  on  the  instant  that  language  is  for  the  purpose  of 
conveying  ideas  from  one  to  another,  and  that  any  word  which  will  do  the 
work  is  a  good  word.  When  we  succeed  in  getting  people  started  thinking 
we  always  feel  we  have  accomplished  something.  By  this  means  we  have 
transformed  $600  a  year  school-teachers  into  $5,000  a  year  doctors. 

A  lot  of  people  come  to  us  with  theories,  both  as  patients  and  students, 
and  they  like  to  exploit  them.  Many  of  them  have  been  gathered  from  "cor- 
respondence courses,"  from  reading  books  written  by  faddists,  from  associat- 
ing with  "reformers"  of  various  kinds,  ranging  from  orthodox  religion  and 
medication  to  the  rankest  kind  of  heterodoxical  vagaries.  We  have  to  be 
prepared  to  handle  them,  and  while  we  always  listen  to  them  because  we 
sometimes  get  good  ideas — negatively  as  a  rule,  but  good,  nevertheless — it  is 
our  business  to  redirect  them,  either  as  patients  or  students,  to  our  well- 
proved  methods,  and  we  have  found  the  best  way  to  silence  them  is  to  take 
a  frank,  deep  interest  in  what  they  have  to  say,  asking  serious  questions, 
many  of  which  they  are  unable  to  answer,  when  finally  it  dawns  on  them, 
without  any  suggestion  from  us,  other  than  the  indirect  one  of  our  questions, 
that  they  do  not  know  much  of  what  they  are  talking  about.  When  they 
get  to  the  point  of  admitting  it,  we  say :  "Very  well,  let  us  tackle  something 
one  of  us  knows  a  good  deal  about,  and  we  will  get  along."  About  the 
worst  class  of  patients  we  find  is  the  man  or  woman  who,  being  in  ill  health, 
and  unfit  for  any  regular  occupation,  takes  up  "humane  work,"  such  as 
protecting  dumb  animals,  children,  closing  saloons,  suppressing  vice,  etc 
Their  "idio-syn-crazies"  are  so  apparent  and  so  fraudulent  that  we  have  to 
handle  them  with  a  club,  at  least  metaphorically,  because  nothing  else  will 
keep  them  in  line.  I  always  tell  such  people  that  their  prejudices  are  a 
handicap,  that  they  are  impudent  to  go  among  comparatively  healthy  people, 
and  undertake  to  instruct  them,  when  their  own  "immorality"  to  themselves, 
indicated  by  their  physical  conditions,  and  physiological  symptoms,  is  so 
apparent  that  they  cannot  have  any  influence  for  good.  They  always  get 
angry  at  this,  and  many  of  them  refuse  to  be  treated  "by  such  a  brutal  man." 
I  tell  them  that  their  aches  and  pains  are  their  own,  they  do  not  hurt  me 
a  particle,  and  it  is  their  privilege  to  stick  to  them  if  they  want  to,  but  they 
will  find  sooner  or  later,  they  will  have  to  admit  to  themselves,  if  not  to 
others,  that  we  told  them  the  truth.  Occasionally  we  get  a  case  that  is 
perfectly  well,  but  for  some  reason  desires  to  take  life  easy  and  deliberately 
plays  sick.  I  recall  a  case  sent  me  by  a  physician  in  a  neighboring  city, 
who  had  taken  a  course  with  us,  and  was  employed  by  a  patient,  after  hav- 
ing been  in  the  hands  of  thirty  or  forty  other  doctors  of  the  city.  The 
doctor  treated  her  a  few  weeks,  and  finally  told  her  husband  he  thought  I 
was  the  only  man  who  could  handle  the  case  successfully.  She  was  brought 


276  A  SYSTEM  OF  MATURE  MEDICINE 

to  me,  and  after  a  preliminary  examination,  in  order  to  be  absolutely  fair 
with  her,  I  kept  her  at  the  college  a  week  under  observation,  and  at  the 
end  of  the  week,  I  sent  for  the  husband,  took  them  both  into  my  private 
office,  and  gave  her  the  talk  of  her  life.  I  told  her  she  was  a  faker,  and 
proved  it  by  the  analysis.  I  told  her  she  was  not  near  as  sick  as  her  hus- 
band was,  and  that  were  I  her  husband,  I  would  desert  her  if  she  did  not 
behave  herself  at  once.  At  first  she  showed  fight ;  next  she  collapsed  and 
confessed  that  I  read  her  like  a  book.  They  went  home,  and  for  some  time 
she  was  resentful  toward  me,  but  she  got  busy,  had  her  mind  occupied  on 
housework  and  other  things  that  made  her  enjoy  rest ;  in  a  few  weeks  she 
got  over  that  resentful  feeling,  and  I  have  had  a  number  of  very  cordial 
letters  from  her,  all  of  which  testifies  that  there  was  a  lot  of  good  in  her. 

Optical  firms  in  Chicago  have  the  habit  of  attempting  to  influence  our 
students  and  graduates  to  use  freak  lenses,  using  the  argument  that  while 
we  have  "the  best  school,"  we  have  "some  queer  notions  about  lenses," 
which  our  "students  repudiate  as  soon  as  they  go  out  in  practice."  I  believe 
they  are  deliberate,  malicious  liars  with  reference  to  our  graduates  because, 
when  students,  they  appeared  to  have  common-sense,  and,  as  they  were 
taught  how  to  test  the  values  of  the  various  lenses,  according  to  natural 
laws,  it  is  only  fair  to  presume  they  would  not  practice  contrary  to  what 
they  know  to  be  true.  I  want  to  go  on  record  here  as  asserting  that  if  any 
of  our  graduates  be  found  using  freak  lenses  or  practicing  retinoscopy,  with 
a  pretense  of  fitting  eyes  therewith,  such  graduates  are  most  likely  not  prac- 
ticing our  methods  in  any  particular  as  they  were  taught,  and  I  advise  the 
public  to  let  them  severely  alone.  If  a  person  who  has  not  had  the  advantage 
of  such  an  ophthalmological  education  as  our  school  affords,  employs  prisms 
and  other  wrong  methods,  there  is  some  excuse  for  it ;  but  when  one  of  our 
graduates  does  it,  he  or  she  is  simply  dishonest.  The  wholesale  and  manu- 
facturing opticians  are  notoriously  ignorant,  hence  their  impudence  in  trying 
to  instruct  graduates.  What  would  be  done  to  a  drug  clerk  who  attempted 
to  advise  a  physician  what  drugs  to  use  in  his  practice,  or  who  undertook 
to  change  prescriptions  handed  him  by  physicians?  Our  work  is  more  exact 
than  any  drug  practitioner's,  hence  the  conduct  of  optical  clerks  is  more 
reprehensible.  The  two  reasons  for  the  impertinence  are,  the  freak  lenses 
yield  more  profits,  and  the  companies  do  not  like  us  a  little  bit  because  we 
teach  the  humbuggery  of  machinery  for  fitting  glasses  to  eyes,  and  that  good 
ophthalmological  work  cannot  be  done  in  stores.  Nearly  all  of  the  wholesale 
opticians  and  optical  paper  editors  have  licenses  under  the  "optometry  laws," 
and  they  secured  those  licenses  by  exemption  from  examination  because  they 
were  in  "practice"  when  said  "laws"  went  into  effect — the  rankest  humbugs 
of  all. 

Different  people  have  different  ideas  about  the  amenities,  of  what  con- 
stitutes refinement,  coarseness,  etc.  Some  express  astonishment,  anger,  and 
other  emotions  in  expletives  ranging  from  "cuss-words"  to  "fudge !"  "mercy 
me !"  "awfully  good !"  "jolly  well,"  "land  sakes,"  "hoot  mon,"  and  so  on,  all 
of  which  mean  the  same  thing;  but  some  of  them  shock  the  artificially  "re- 
fined" while  they,  in  turn,  disgust  honest  souls.  But  those  are  minor  things 
as  they  do  not  involve  high  principles.  I  do  not  mind  hearing  a  person  swear 


IDIOSYNCRASIES,  PROFESSIONAL  AND  TRADE  '2771 

who  knows  how  to  do  an  artistic  job ;  it  shows  force  of  character.  A  much 
worse  fault  is  snobbishness.  It  may  exhibit  in  many  ways ;  but  I  know  of 
none  which  gives  surer  evidence  of  coarse,  rank  egotism  than  that  exhibited 
by  people  of  prominence  or  who  assume  importance  and  undertake  to  imitate 
high  government  officials  whose  position  warrants  and  even  requires,  for 
reasons  of  state,  that  they  do  their  correspondence  through  private  secre- 
taries. I  have  had  some  experiences  with  such  people,  who,  asking  personal 
favors,  addressed  me  through  secretaries,  no  doubt  seeking  to  impress  me 
with  their  ponderosity.  The  effect  was  just  the  reverse,  and  I  am  sure  all 
who  possess  Natural  instincts  would  be  impressed  likewise. 

After  many  years  of  experience  with  people,  sick  and  well,  as  students, 
patients,  antagonists  in  the  field  of  argument,  and  experience  generally,  I 
declare  without  hesitation  or  classification,  that  there  is  more  good  than 
bad  in  each  and  everyone  of  us.  I  have  learned  to  abhor  that  which  is  not 
good  in  an  individual  without  any  feeling  whatever  against  the  individual. 
I  have  learned  to  appreciate  good  wherever  I  find  it,  without  particularly 
exalting  the  individual  possessing  it,  and  I  recommend  that  everyone  culti- 
vate such  discrimination,  as  it  will  conduce  to  happiness  and  do  away  with 
grouches.  If  some  neighbor  has  a  bad  habit,  do  not  despise  the  neighbor. 
That  is  not  good  sense.  There  is  a  class  of  people  who  get  the  notion 
that  because  I  roast  certain  matters  and  things  in  my  paper,  I  am  a  horrible 
old  ogre,  who  goes  around  with  a  chip  on  his  shoulder,  gnashing  his  teeth, 
and  slobbering  tobacco  juice  on  long  whiskers.  When  they  come  here,  they 
are  utterly  dumfounded,  and  exhibit  it  when  they  discover  they  are  talking 
to  the  man  of  whom  they  formed  such  opinions,  and  that  he  is  rather  a 
jolly  good  fellow,  without  any  whiskers,  tobacco  juice,  or  grouch.  They  often 
express  their  astonishment  orally,  saying:  "I  expected  to  see  a  great  big 
man  with  long  whiskers,  and  very  serious."  And  I  add  "tushes  and  tobacco 
juice,  ready  to  fight  at  the  drop  of  the  hat,  etc.,  etc."  Then  they  admit  it. 
One  physician,  member  of  the  A.  M.  A.,  who  had  been  treated  by  St.  Louis. 
New  York,  Chicago,  and  other  oculists,  for  twenty  years,  who  has  an  office 
in  the  Reliance  building,  Chicago,  where  none  but  A.  M.  A.  members  are 
admitted,  was  told  by  one  of  his  neighboring  doctors,  when  he  was  com- 
plaining that  the  "fogging  system"  as  it  had  been  used  on  him  for  twenty 
years,  had  pretty  nearly  used  him  up,  that  "the  father  of  the  fogging  sys- 
tem" lives  in  Chicago,  and  gave  him  my  address.  He  came  out  and  asked 
for  me,  after  having  read  some  of  my  literature,  and  when  I  appeared  he 
shook  hands,  and  blushed  like  a  school  girl,  saying:  "I  think  I  want  to  see 
an  elderly  gentleman,"  and  when  I  responded  that  I  was  the  elderly  gentle- 
man he  was  looking  for,  he  nearly  collapsed.  He  made  a  very  good  patient, 
and  came  out  all  right  in  a  few  weeks.  I  tell  these  things  so  the  reader 
may  see  how  I  have  learned  to  give  and  take,  how  I  have  learned  to  analyze. 
If  I  have  anything  to  say  about  any  subject,  or  person,  I  fire  away,  but  I 
am  exactly  like  a  gun,  after  I  have  fired,  I  am  empty.  I  carry  no  grudges, 
for  my  own  self-protection.  Life  is  too  short,  and  it  is  against  true  phi- 
losophy to  keep  the  emotions  stirred  in  one  direction.  I  study  people  as  I 
study  books.  I  will  read  anything.  I  do  not  have  to  believe  it  unless  it 
appeals  to  my  reason.  I  study  people ;  not  for  the  individuals,  but  for  what 


278  A  SYSTEM  OF  MATURE  MEDICINE 

I  can  get  out  of  them  in  the  way  of  information.  I  am  not  the  originator 
of  this  idea  by  any  means.  We  read  in  the  bible  that  St.  Paul  declared  he 
could  learn  from  the  Greeks  or  from  the  Barbarians ;  he  was  one  of  the  early 
members  of  my  class,  and  while  he  was  a  fanatic,  he  certainly  had  good 
elements  in  him,  which  cropped  out,  and  we  commend  the  good  and  pass 
up  the  bad  as  a  weakness.  If  everyone  would  regard  what  they  call  evil.as 
an  exhibit  of  weakness,  more  deserving  of  pity  than  censure,  criticism  would 
not  be  so  common.  The  world  is  full  of  politicians,  and  others  of  their  ilk, 
in  whom  the  selfish,  covetous,  arrogant,  insolent,  cruel  weaknesses  are  their 
dominant  "idio-syn-crazies" ;  hence  it  is  necessary  for  some  of  us  who  think 
to  stand  between  them  and  the  people  they  would  impose  on,  by  exposing 
them  to  those  people.  That  is  the  reason  I  fight  the  church,  the  politician, 
and  grafters  in  general,  and  I  fight  them  with  a  weapon  they  fear  the  most 
— publicity.  I  have  no  personal  grudges  against  them,  but  they  all  have  per- 
sonal grudges  against  me  because  of  my  exposes.  There  is  not  one  of 
them  but  would  go  far  out  of  his  way  to  be  nice  to  me,  if  by  so  doing  he 
could  secure  immunity  from  exposure.  I  do  not  hate  the  individual,  but  I 
do  hate  the  principle  he  exhibits,  or  rather  the  lack  of  principle,  and  I  will 
fight  as  long  as  I  have  capacity  to  fight.  That  is  my  "idio-syn-crazy,"  or 
one  of  them,  at  least. 


APPENDIX 

Paragraphic  Information,  Physical,  Physiological,  Symptomological,  Clinical. 

To  find  the  thickness  of  any  lens  at  any  distance  from  its  edge : 
For  -)-  lenses,  take  one-half  of  the  length  or  width  of  the  lens,  in  mm. ; 
square  it;  point  off  three  decimals;  multiply  by  the  dioptric  power  of  the 
lens;  add  the  product  to  the  thickness  of  lens  at  edge;  result,  thickness  of 
lens  at  middle.  Thus,  a  -j-  10.00  lens,  1  mm.  thick  at  edge  and  40  mm.  long,  is 
20  mm.  from  one  end  to  middle;  20X20  =  400;  pointing  off  three  decimals 
gives  .400;  multiply  by  the  dioptric  power  of  lens,  10,  gives  4.000;  adding 
this  to  thickness  at  edge,  1,  gives  5  mm.  thickness  at  middle.  Now,  to  find 
thickness  at  any  other  point,  square  the  distance  from  the  middle  and  point 
oil  three  decimals ;  multiply  by  the  dioptric  power  and  subtract  from  thick- 
ness at  middle.  The  distance  from  middle  to  edge  is  20 ;  squaring  it  gives 
400 ;  pointing  off  three  decimals  gives  .400 ;  multiply  by  dioptric  power,  10, 
gives  4.000 ;  subtracting  from  thickness  at  middle  leaves  1  mm.  thick  at  edge. 
Or,  at  10  mm.  from  the  middle  we  have  10,  squared,  equals  100 ;  pointing  off 
three  decimals  gives  .100 ;  multiplying  by  the  dioptric  power,  10,  gives  1.000 ; 
subtracted  from  thickness  at  middle,  leaves  4  mm.  thickness  at  10  mm.  from 
middle.  To  find  the  distance  from  the  center  of  the  lens  to  where  the  two 
surfaces  would  meet  at  a  knife  edge,  find  the  square  root  of  the  thickness  at 
middle  and  multiply  it  by  the  power  of  the  lens. 

For  —  lenses,  take  one-half  of  the  length  or  width  of  the  lens,  in  mm. ; 
square  it ;  point  off  three  decimals ;  multiply  by  the  dioptric  power  of  the 
lens ;  subtract  the  product  from  the  thickness  at  edge ;  result,  thickness  of 
lens  at  middle.  Thus  a  -  -  10.00  lens,  5  mm.  thick  at  edge  and  40  mm.  long, 
is  20  mm.  from  one  edge  to  middle;  20X20  =  400;  pointing  off  three  decimals 
gives  .400 ;  multiply  by  the  dioptric  power  gives  4.000 ;  subtracting  this  from 
the  thickness  at  edge,  5,  leave  1  mm.  thickness  at  middle.  Now,  to  find  the 
thickness  at  any  other  point  than  the  middle,  measure  the  distance  from  the 
middle;  square  it;  point  off  three  decimals;  multiply  by  the  lens  power; 
add  thickness  at  middle;  subtract  from  thickness  at  edge.  The  distance 
from  middle  to  edge  is  20  mm. ;  squaring  it  gives  400 ;  pointing  off  three 
decimals  gives  .400 ;  multiplying  by  the  power  of  the  lens,  10,  gives  4.000 ; 
adding  thickness  at  middle,  .1,  gives  5,  which  is  the  thickness  of  lens  at  edge. 
Or,  10  mm.  from  the  middle  we  have :  10  squared  equals  100 ;  pointing  off 
three  decimals  gives  .100 ;  multiplying  by  dioptric  power,  10,  gives  1.000 ; 
adding  thickness  at  middle,  1,  makes  2.000;  and  5.000  less  2.000  gives  3  mm. 
as  the  thickness  10  mm.  from  the  middle. 


280  A  SYSTEM  OF  MATURE  MEDICINE 

Being  given  the  power  of  a  lens  desired,  its  thickness  and  the  index  of  re- 
fraction, to  find  the  radii  for  a  bi-convex  which  will  give  the  exact  focal 
distance  from  the  nodal  points,  the  following  procedure  is  the  best  because 
it  is  simplest :  Multiply  the  principal  focal  distance  indicated  by  the  dioptric 
number  by  the  index  and  divide  the  product  by  the  excess  index ;  then  sub- 
stract  one-half  of  the  thickness  of  the  lens ;  the  result  will  be  F2  of  either 
surface  of  the  lens  when  made  properly.  Ordinarily  a-f-3.00  would  be  figured 
on  the  basis  of  333^  mm.,  which,  multiplied  by  the  excess  index,  would  give 
the  radius  for  a  plano-convex  lens  of  the  required  power,  and  for  a  bi-convex 
it  is  customary  to  double  the  radius  thus  found ;  but  that  is  incorrect  when 
the  thickness  of  the  lens  is  to  be  considered.  The  rule  given  above  works 
as  follows,  the  lens  to  be  4  mm.  thick : 

333  JX 1-50  =  500-f-.oO  =  1000—2  =  998  =  new  F2  for  either  surface. 

F1  is  found  by  dividing  F2  by  the  index. 

Multiply  F1  by  excess  index  for  R. 

998-^-1.50  ==  665i X- 50  =  332|  R  for  each  surface. 

F".  less  thickness  of  lens,  multiplied  by  F1          T-.T-   r  -.i  r 

rr- : nr~i T~i ~\ — ^2 =rr    from  either  surface 

r  ,  less  thickness  of  lens,  plus  F 

998-  -4  =  994X665%  =  661341%        QCM  ?4t3  T^  ,  vu  r 

998-4  =  994-^98  =  1992        ==331^PF  ^  Cltll€r  SurfaCe' 

The  optical  center  being  always  midway  between  the  surfaces  of  equally 
curved  bi-convex  lenses,  the  distance  from  each  surface  in  this  instance  is 
2  mm.  This  distance,  multiplied  by  F1  and  the  product  divided  by  F2 
less  the  optical  center  distance,  we  have : 

2X665%  =  1330%  ,    ,     ,.  ,  , 

— An-    0 — „,.„     =l^-rrthe  nodal  distance  from  each  surface. 

9m — 2  =  996  <  4  i 

Adding  the  nodal  distance  to  the  PF  from  the  surface  we  have  33  ^—  PF 
from  the  nodal  points.  This  is  not  absolute  but  is  only  off  1/747  of  a 
millimeter;  3331  would  be  exactly  333—. 

'  747 


Indexes  of  refraction  of  artificial  substances  are,  of  course,  only  approx- 
imate, notwithstanding  claims  of  optical  manufacturers  to  the  contrary. 
There  are  laws  governing  the  matter  which  none  of  them  appear  to  know 
anything  about.  If  they  did  they  would  not  make  the  claims  they  do  with 
reference  to  lenses,  which  the  lens  .themselves  contradict.  Take,  for  ex- 
ample, the  claims  of  superiority  of  Crooke's  glass  absorbing  actinic  rays,  the 
kryptok  bifocals  being  "inconspicuous,"  the  deep  meniscus  forming  "more 
perfect  pictures"  and  having  a  form  which  "can  be  set  closer  to  the 
eyes :"  The  first  is  only  a  theory,  possibly  practical  for  men  in  front  of  a 
blast  furnace,  but  only  then  if  the  glass  be  made  so  thick  it  would  be  a 
cumbersome  thing  to  wear,  and  would  do  more  harm  in  other  ways  than 
good  in  that  particular;  the  second  is  expensive  because,  when  reading  por- 
tions require  changing,  new  lenses  have  to  be  made  and  the  chromatic  aberra- 
tion of  the  insert  is  a  bad  feature ;  the  third  are  conspicuous,  their  optical  cen- 
ters are  away  out  in  front  of  the  lenses,  the  pictures  formed  by  them  alongside 
of  those  of  the  bi-convex  trial  lenses  of  the  same  indicated  powers  are  not 
nearly  so  good,  and  the  fact  that  the  curve  is  toward  the  eye,  instead  of 
from  it,  as  in  the  bi-convex,  prevents  placing  the  meniscus  as  close  to  the  eye 


APPENDIX  .  281 

as  the  bi-convex  when  the  object  is  to  avoid  the  sweeping  of  the  glass  by 
the  lashes.  Then  the  fairy  stories  they  tell  about  "punktal,"  "euphos"  and 
other  alleged  wonderful  lenses,  are  on  a  par  with  the  old  "parabolas,"  "medi- 
cated," "electric,"  and  other  fake  lenses. 


No  colored  or  tinted  lenses  should  be  used  in  practice,  except  that  piano 
smoked  lenses  may  be  used  by  persons  on  snow  or  water  when  the  reflections 
are  too  glaring  for  comfort ;  and  correcting  lenses  for  Albinoes'  day  use 
should  be  made  from  darkly  smoked  glass,  because  such  people  have  no 
pigment  in  either  iris  or  retina  and  need  protection.  They  nearly  all 
have  St.  Vitus'  dance  from  a  combination  of  the  refractive  error  causing 
strain  on  the  nervous  system  generally,  and  the  excess  of  light  which  irri- 
tates the  system,  via  the  retina.  Nature  made  green  grass  and  trees, 
yellow  fields,  and  a  great  variety  of  colors  and  shades  of  colors,  and  to  put 
on  lenses  of  one  color  or  shade  destroys  all  those  beauties  and  injures  the 
perceptive  qualities  of  the  retina. 


The  practice  of  prescribing  cylinders  of  less  than  .50  power  is  a 
very  foolish  one,  and  offers  the  best  of  proof  that  prescriber  does  not  know 
physical  optics  nor  physiological  Ophthalmology.  The  change  in  -the  focal 
distance  of  a  meridian  caused  by  .50  error  is  approximately  one-eighth  of  a 
millimeter ;  that  caused  by  .25  error,  one-sixteenth  of  a  millimeter  and  that 
caused  by  .125  error,  one-thirty-second  of  a  millimeter.  My  experience  is  that 
people  who  correct  eighth  and  quarter  diopter  errors  are  the  ones  who  over- 
look whole  diopters.  A  recent  student  in  our  Department  of  Ophthalmology 
came  wearing  +.50  spheres  "toric,"  his  appearance  reminded  me  of  auto- 
mobile headlights ;  he  had  headaches  and  indigestion ;  he  had  been  "fitted" 
by  an  "expert."  In  our  clinic  we  had  no  difficulty  in  finding  2.50  hyperopia. 
His  headaches  and  other  symptoms  disappeared  in  two  weeks,  completely. 


A  student  came  to  us  from  a  Toronto  "optical  college"  where  the  "pro- 
fessor" had  "fitted"  him  with  a  —  1.75  axis  180.  One  of  our  senior  students 
found  -f-  2.50-}-. 75  axis  90,  and  with  this  correction  vision  came  to  20/20  in 
three  weeks. 


In  cases  of  high  errors,  say  6.00  or  more  diopters,  if  there  is  1.00  diopter 
or  less  astigmatism  it  is  advisable  to  ignore  it,  (unless  the  lens  is  to  be  made 
in  a  correct  sphero-toric  form),  and  prescribe  a  simple  bi-convex  sphere 
of  a  power  equal  to  the  meridian  of  greatest  hyperopia  or  of  least  myopia. 
The  proper  sphero-toric  form  for  a  lens  +6.00+1.00  axis  90  would  be  +3.50 
-}-2.50-)-1.00  axis  90.  Thus  the  3.50  would  be  the  spherical  surface,  and  the 
+2.50+1.00  axis  90  the  toric  surface,  and  such  a  lens  would  be  bi-convex 
in  both  meridians,  +3.50+3.50  in  the  horizontal,  and  +3.50+2.50  in  the 
vertical.  It  would  have  two  optical  centers ;  the  one  in  the  horizontal  plane 
would  be  midway  between  the  surfaces,  and  the  one  in  the  vertical  plane 
would  be  5/12  of  the  thickness  of  the  lens  from  the  +3.50  surface  and  7/12 
of  the  thickness  from  the  +2.50  surface. 


A  SYSTEM  OF  MATURE  MEDICINE 


True  Ophthalmologists,  such  as  our  students  have  to  be  before  they  re- 
ceive diplomas,  are  not  sellers  of  glasses.  They  are  Doctors  of  Ophthalmol- 
ogy, and  as  such  they  are  taught  to  take  plenty  of  time  in  making  examin- 
ations, following  a  regular  form  of  procedure,  which  precludes  the  possi- 
bility of  omitting  anything.  In  getting  patients'  histories  special  suggestions 
come  to  the  examiner  in  each  case,  and  all  should  be  heeded  and  analyzed. 
For  example,  if  one  says  he  has  been  told  he  has  "heart  disease,"  it  is  proper 
to  make  an  examination  at  once ;  if  it  is  too  fast  or  too  slow,  or  misses  beats, 
lay  the  patient  on  his  back,  and  after  a  few  minutes  examine  again,  when 
it  will  be  found  in  nearly  all  cases  there  is  a  remarkable  change,  beats  being 
regular  and  strong.  We  have  had  hundreds  of  cases  of  this  sort  of  "heart 
disease,"  and  with  eye  corrections  and  a  few  simple  instructions  they  were 
troubled  no  more.  The  great  surgeon,  J.  B.  Murphy,  who  died  last  August 
of  "heart  disease",  "diabetes",  and  other  complications,  requested  his  friends 
among  surgeons  to  make  an  autopsy  to  settle  a  difference  of  opinion  between 
himself  and  them.  The  day  after  he  died  they  spent  four  hours  over  the 
body  and  finally  announced,  gravely,  that  "he  was  right  and  we  were  wrong- 
in  the  diagnosis  of  his  case."  There  are  two  rather  conspicuous  features 
in  the  matter,  First,  Dr.  Murphy  was  not  yet  fifty-nine  years'  old ;  he  was 
a  great  diagnostician  and  a  great  surgeon ;  he  diagnosed  his  own  case  cor- 
rectly, but  did  not  possess  the  skill  to  "cure"  himself  and  died  young.  Second 
the  other  great  doctors  diagnosed  his  case  as  something  which  the  autopsy 
by  them  proved  untrue ;  in  confessing  he  was  right  they  paid  him  a  doubtful 
tribute — because  he  knew  what  was  the  matter  but  could  not  change  the 
situation — and  they  hit  themselves  a  blow  by  confessing  double  ignorance. 
As  a  matter  of  fact  there  is  no  such  a  thing  as  "heart  disease."  It  is  my 
firm  belief  that  if  Dr.  Murphy  had  worn  a  correction  of  his  hyperopia,  and  had 
known  how,  when,  what  and  how  much  to  eat,  how  to  rest,  bathe,  etc.,  he 
could  have  survived  many  years.  We  have  had  many  such  cases  among 
our  physician  students,  and  all  became  perfectly  well  while  taking  our  work. 


Presbyopia  should  not  appear  before  the  age  of  forty-five  and  rarely  before 
fifty.  It  would  never  do  so  if  the  eye  errors  were  corrected  in  time,  and  the 
contributing  causes  of  premature  weakness  were  removed  by  proper  at- 
tention of  Nature's  laws.  Anyone  under  forty-five  who  exhibits  this  symptom 
should  be  ordered  to  cease  work  and  follow  a  strict  regimen  until  the 
Neurometer  shows  the  case  to  be  above  its  safety  line.  Bifocals  for  young 
people  are  ridiculous,  and  disgraces  to  the  doctor  who  prescribes  them. 
WThen  people  are  really  of  the  presbyopic  age  the  best  lenses  for  them  are 
bifocals  with  the  scales  cemented  on  the  outside  of  lens,  and  one  millimeter 
up  from  the  edge ;  the  lashes  do  not  sweep  them  and  oil  the  edge  causing 
a  softening  of  the  cement  and  accumulation  of  dirt.  The  scale  should 
be  oval,  about  14  x  16  millimeters.  I  have  worn  one  pair  for  eight  years  and 
they  are  as  solid  as  when  new,  with  no  dark  circles  around  the  edges,  so 
often  seen  on  those  with  the  scale  on  the  inside.  The  optical  houses  de- 
clare the  spherical  surface  of  a  compound  lens  should  be  on  the  inside 
and  that  scales  should  be  inside.  They  have  no  reasons  for  either  assertion. 
It  would  be  amusing  if  their  silliness  was  never  harmful.  The  American 


APPENDIX  283 

people  are  so  complacent  they  believe  assertive  people  without  question, 
but  if  one  who  knows  offers  to  explain  truths  to  them,  they  regard  it  as  an 
apology,  hence  our  advice  to  our  graduates  is  to  "give  orders;  never  make 
requests;  if  you  want  a  good  reputation,  live  your  work  according  to  natural 
law,  and  when  commercial  concerns  offer  suggestions  as  to  how  to  practice, 
tell  them  to  hand  that  stuff  to  the  oculists  and  'optometrists'  who  may  take  it ; 
tell  them  their  remarks  are  offensive  and  insulting  to  you,  and  you  will  not 
tolerate  them." 


In  view  of  fact  that  Volume  II,  completing  this  work,  will  be  out  some 
time  next  year,  it  is  not  out  of  place  to  prepare  the  readers  for  it :  For 
many  years  I  have  taught  the  values  of  simple,  natural  remedies.  Would-be 
critics  have  ridiculed,  etc.  It  is  gratifying  to  note  that  they  are  all  changing 
their  minds.  Professor  Agassiz  told  a  New  York  audience,  some  years  age. 
that  there  are  three  stages  of  change  of  opinion :  First,  when  anything 
different  is  proposed,  "it  must  be  false  because  it  is  different,"  second,  "it. 
has  been  discovered  before,"  third,  "we  always  believed  it."  When  I  first 
promulgated  my  propositions  they  were  hooted  at ;  next  they  were  imitated 
10  a  degree ;  now  they  are  being  appropriated  and  announced  as  original 
discoveries  by  the  very  people  who  hooted  two  decades  ago :  Dr.  Sir  Wm. 
Osier  of  Oxford,  England,  formerly  of  America,  who  is,  by  virtue  of  his 
appointment  by  the  King  of  England,  regarded  as  the  most  august  person 
age  among  old-school  doctors,  was  so  orthodox  while  at  Johns  Hopkins,  the 
University  of  Pennsylvania  and  McGill  College,  that  his  book  "The  Practice 
of  Medicine"  is  replete  with  "cures"  which  failed.  It  is  refreshing  to 
read  his  recent  signed  contribution  to  the  Encyclopedia  Americana,  in 
which  he  announces  the  old  as  ''the  new"  school.  He  says  the  change 
is  "the  result  partly  of  the  remarkable  experiments  of  Paris  and  Vienna 
schools  into  the  action  of  drugs,  which  have  shaken  the  stoutest  faiths."  He 
cites  the  fact  that  while  the  "regulars"  ridiculed  the  "homeopaths"  and  their 
"infinitesimals"  the  latter  lost  noj  more  of  their  patients  than  the  others, 
as  one  of  the  proofs  of  the  worthlessness  of  drugs.  He  endorses  Neurology — 
he  does  not  name  it,  of  course,  but  every  sense  of  his  article  is  such  as  I 
have  been  writing  for  twenty  years :  The  importance  of  natural  methods, 
of  diet,  of  baths,  of  massage,  of  education.  But  with  it  all  he  is  still  twenty 
years  behind  this  old  scout,  as  I  shall  prove  in  my  next  book,  in  addition 
to  what  I  have  proved  in  this  one.  The  next  thing1  I  expect  to  hear  is  that 
they  have  adopted  our  methods  of  teaching;  but  there  is  one  thing  in  the 
way  of  that — they  haven't  the  teachers.  I  would  like  to  see  one  of  their 
astute  "professors"  tackle  his  subject,  without  notes,  for  six  hours  each  day 
for  days  at  a  time. 

In  connection  with  the  foregoing  paragraph  it  will  be  interesting  to 
the  reader  to  know  that  Sir  Almroth  Wright,  of  the  British  medical  staff, 
the  inventor  of  the  "opsonic  index"  and  an  "authority"  on  "serums"  has 
utterly  repudiated  them,  and  has  adopted  the  "salt  water"  treatment  of 
wounds  for  the  purpose  of  promoting  the  flow  of  lymph  which  he  pro- 
nounces the  greatest  healer.  He  declares  the  lymphatic  system  has  been 


284  A  SYSTEM  OF  MATURE  MEDICINE 

regarded  of  secondary  importance  until  now.     For  over  twenty  years  I  have 
taught  in  my  school  that  the  four  great  systems  of  the  body  are : 

1.  The  Nervous  system,  including  nervous  energy. 

2.  The  Lymphatic  system,  including  all  circulation. 

3.  The  Digestive  system,  including  assimilation  and  metabolism. 

4.  The  Egestive  system,  including  fourteen  departments. 

Our  internal  materia-medica  is  body  and  food  chemistry,  massage,  baths, 
nursing.  Our  external  materia-medica  is  baths,  turpentine,  salt  water,  lemon 
juice,  with  adhesive  plaster  instead  of  stiches,  wherever  possible,  adjust- 
ments, massage,  hot  applications,  instead  of  cold,  and  special  attention  to  the 
bowels  and  bladder.  Natural  methods,  all  of  them ;  sure  to  do  good  if  it  is 
possible,  with  no  possibility  of  harm  in  any  case. 

Then  comes  Dr.  Richard  C.  Cabot,  Professor  of  Medicine  in  Harvard, 
with  his  frank  statement,  uttered  in  Boston,  June  5,  1916. 

"The  physician  is  yet  in  the  peddler  stage,  and  the  surgeon  has  not  yet 
been  lifted  out  of  the  cobbler  stage.  We  physicians  are  like  the  old-time 
shoemakers.  We  don't  specialize.  When  you.  see  a  doctor  put  up  a 
shingle  'physician  and  surgeon',  you  have  convincing  proof  he  is  neither." 


In  prescribing  for  cases  of  compound  myopia,  where  the  cylinder  is  of 
considerable  strength,  it  is  best  to  give  temporary  lenses,  using  the  cylinder 
alone.  This  will  give  improved  vision  for  long  distances,  and  more  comfort 
for  close  work;  then,  after  the  patient  has  become  accustomed  to  wearing 
glasses,  the  spherical  addition  may  be  made  in  the  final  correction ;  but 
great  care  should  be  exercised  to  not  over-correct  the  error,  because  that 
would  create  hyperopia  artificially  and  develop  systemic  disorders.  A  good 
rule  is  to  never  correct  any  myope  to  better  than  20/30  vision  until  after 
he  has  reached  the  presbyopic  stage.  In  all  cases  of  very  high  amount  of 
myopic  error,  whether  it  be  compound  or  simple,  partial  corrections  should 
be  given  at  first,  and  gradually  increased  as  the  patient  adapts  himself  to 
the  lenses.  In  cases  where  there  is  a  posterior  staphyloma,  it  is  some- 
times possible  to  get  a  fairly  good  vision,  say  20/80,  with  very  strong 
minus  lenses,  but  it  is  not  advisable  to  prescribe  them,  because  it  invariably 
over-corrects  the  myopia  and  increases  the  trouble. 


In  the  subdivisions  of  errors  we  have  simple  hyperopia,  simple  myopia, 
simple  hyperopic  astigmatism,  simple  myopic  astigmatism,  compound  hyper- 
opic  astigmatism,  compound  myopic  astigmatism,  mixed  astigmatism,  as 
the  seven  regular,  correctible  errors.  In  figuring  nerve  strain  we  put  the 
four  varieties  of  hyperopia  and  mixed  astigmatism  all  in  one  class,  and 
figure  on  the  meridian  of  greatest  hyperopia  in  all  of  the  astigmatic  cases 
as  if  it  were  simple  hyperopia.  Myopes  ,of  course,  have  no  nerve  strain 
unless  they  work  many  hours  overtime  at  close  range,  and  even  in  such 
cases  we  do  not  figure  the  strain  by  the  amount  of  error  as  we  do  in 
hyperopia.  In  fact  it  is  unnecessary  to  figure  nerve  strain  in  myopia  at  all. 


For  twenty-five  years  I  have  been  correcting  anisometropia.     The  old 
writers,  and  the  modern  ones  of  the  old-school,  teach  that  this  cannot  be  done 


APPENDIX  285 

because  the  patient  will  not  "tolerate"  it.  I  discovered  that  they  apparently 
regarded  the  intoleration  exhibited  by  complaints  of  discomfort  in  the  same 
sense  that  they  did  the  exhibits  caused  by  drugs,  and  I  knew  that  the  exhibit 
from  lenses  was  due  to  mechanical  causes,  necessitating  readjustment  of 
nervous  distribution ;  hence  I  informed  patients  that  there  would  be  trouble 
at  first,  but  it  was  worth  going  through,  in  order  to  save  the  unused  eye,  and 
insure  complete  comfort  later,  and  I  assured  them  that  if  they  would  fight 
it  out,  they  would  bless  me  later.  In  all  cases  where  instructions  were 
followed,  the  finest  results  accrued.  I  have  even  taken  cases  where  one 
eye  was  blind  from  non-use,  and  by  giving  it  the  same  correction  pre- 
scribed for  the  other  eye  at  first,  changing  it  later  as  vision  developed,  much 
good  was  done,  even  to  getting  perfect  vision  in  the  bad  eye. 


I  have  always  been  a  stickler  for  standards  in  practice.  By  this  I  mean 
that  in  comparing  any  two  propositions  in  the  same  category,  I  established 
one  of  them  as  a  unit.  For  example,  the  index  of  various  transparent 
mediums  is  established  from  the  unit  1.00,  of  air;  thus  water  is  1.33^  and 
glass  1.50 ;  in  comparing  water  and  glassl  I  make  1.33^  the  unit,  l.QO. 
Thus  the  1.50  compared  with  it  becomes  1.125.  I  have  found  it  easier  to 
to  understand  and  easier  for  my  pupils  to  understand.  Then  I  apply  the 
principle  to  my  work  generally  and  in  the  Neurometer  it  exhibits  in  its 
highest  form  of  value.  In  the  examination  of  a  case  where  we  go  into  de- 
tails with  reference  to  appearance,  history,  ophthalmoscope,  vision,  dynamic, 
static,  and  measurement  of  the  error,  we  have  the  standards  in  each  based 
upon  physics,  anatomy,  physiology,  chemistry,  mechanics,  symtomatology, 
metaphysics,  and  experience,  and  we  work  by  regular  procedures,  either  bring- 
ing cases  up  to  those  standards  or  finding  exactly  how  far  they  are  from 
the  standards  in  each  section  of  the  work.  From  the  data  thus  obtained,  we 
not  only  analyze  individual  cases,  but  we  acquire  a  skill  which  prepares  us  for 
each  succeeding  case.  Of  course  we  do  not  expect  readers  of  the  book  to 
be  able  to  comprehend  the  importance  of  these  items  entirely  as  they  would 
if  they  were  in  the  school  under  instruction,  but  to  the  real  student  who 
does  not  try  to  be  too  technical,  and  merely  follows  the  plain  meaning  of 
our  statements,  the  book  will  be  an  invaluable  aid. 


One  very  important  thing  in  connection  with  fitting  glasses,  which  few 
practitioners  know,  is  the  physics  of  the  test  card.  To  be  skillful  every  op- 
erator should  know  how  to  calculate  whether  or  not  the  letters  on  the  card 
are  of  the  sizes  they  should  be  for  the  distance  used ;  next  he  should  know 
that  when  the  various  sized  letters,  made  for  different  distances,  are  all  at  one 
distance,  their  values  are  as  variable  as  the  distances  they  were  made  for 
are  variable  from  the  working  distance,  and  he  should  be  able  to  calculate 
mentally  the  amount  of  improvement  in  vision  at  each  change  of  lenses.  To 
do  this  he  must  have  a  standard,  and  it  must  be  made  either  from  an 
emmetrope,  or  from  a  corrected  hyperope  who  is  presbyopic.  I  found  that 
a  corrected  hyperope  who  was  practically  totally  presbyopic  was  fogged 
to  20/200,  with  a  pair  of  -f-  1.50  spheres ;  hence  I  fixed  as  a  standard  the 
proposition  that  when  I  fog  any  patient  until  he  sees  only  the  200  line 


286  A  SYSTEM  OF  MATURE  MEDICINE 

at  20  feet  no  matter  how  strong  the  lens  is,  he  must  have  hyperopia  of  at 
least  the  amount  of  that  lens  less  1.50,  and  very  often  much  more  is  found. 
This  is  particularly  true  in  young  people  where  we  find  often  cases  with  a 
-f-  3-00  fogging  at  first,  yet  we  are  able  to  put  as  much  as  3.50  or  4.00 
later.  In  unfogging  from  the  200  line  if  -  -  .50  permits  the  120  line  to  be 
seen,  it  means  the  lenses  dropped  the  vision  80  feet;  as  the  next  line  on 
most  cards  is  80,  and  as  the  difference  between  120  and  80  is  only  40,  an 
increase  of  .25,  making  the  minus  lenses  .75,  ought  to  bring  vision  to  the 
80  line,  and  if  it  does  not,  it  indicates  accommodative  resistance  or  spasm ; 
if  it  gives  better  vision  than  the  80  line,  it  indicates  accommodative  relaxation, 
and  as  —  .25  brought  vision  60  feet,  the  next  increase  of  —  .25  ought  to  bring 
normal  vision,  or  possibly  better,  and  if  it  does  the  latter  we  don't  give  it. 
It  is  a  good  rule  in  unfogging  one  eye  at  a  time  to  stop  at  the  30  line  if 
working  at  20  feet,  and  when  both  eyes  are  used  together,  there  will  often 
be  sufficient  relaxation  of  accommodation  to  permit  normal  vision  and  some- 
times better.  In  the  latter  case  we  slip  in  a  pair  of  stronger  -)-  lenses, 
after  which  we  remove  the  others,  and  in  some  cases  we  are  able  to  force 
on  considerably  stronger  lenses.  It  is  in  working  out  these  details,  arid 
many  others,  that  we  have  found  the  skill  required  to  fit  a  pair  of  glasses  prop- 
erly has  to  be  superior  to  that  required  for  any  surgical  operation ;  and  even 
then  no  one  will  ever  become  expert  enough  to  finish  a  case  at  one  sitting,  ex- 
cept under  presbyopic  conditions. 


Do  not  forget  the  astigmatic  chart,  the  stenopaic  disk,  and  other  con- 
trivances to  be  found  in  trial  cases  are  only  conveniences  and  aids  when 
used  intelligently,  and  that  they  are  not  by  any  means  infallible,  even  in 
the  hands  of  the'  most  expert  operators.  Some  people  see  differences  in 
the  astigmatic  charts  when  they  have  no  astigmatism  whatever,  and  practi- 
cally all  of  these  will  say  the  vertical  lines  are  the  blackest.  This  is  be- 
cause the  majority  of  objects  looked  at  are  most  distinct  in  the  vertical  me- 
ridian, because  there  is  more  of  it ;  a  person,  for  example,  is  from  five  to 
six  feet  tall,  and  less  than  two  feet  wide,  thus  even  a  spherical  eye  uses  its 
vertical  meridian  at  the  retina  much  more  constantly  than  the  horizontal ; 
hence  develops  its  acuity  to  a  higher  degree.  Those  who  fit  weak  cylinders 
to  such  eyes  make  a  great  mistake.  In  fact  those  who  fit  cylinders  to  people 
who  have  normal  vision  without  them  are  as  foolish  as  those  who  fit 
minus  lenses  to  people  with  normal  vision.  It  is  an  incontrovertible  fact  that 
no  myope,  nor  any  person  with  astigmatism  of  an  amount  worth  correcting, 
could  see  normally  with  the  naked  eye.  It  is  true  that  some  hyperopes  who 
have  astigmatism  can,  by  squinting  and  making  a  slot  with  their  lids,  read 
20/20,  but  no  operator  should  be  deceived  by  that.  He  should  keep  his 
eyes  on  the  patient,  and  see  that  in  the  vision  test  he  keeps  his  eyes 
open.  While  at  the  University  of  Pennsylvania  Medical  School,  Dr. 
Black  was  told  by  the  Professors  of  Ophthalmology,  and  other  oculists, 
that  he  was  an  emmetrope  because  he  read  normally.  They  did  not  watch 
him  when  he  was  reading  as  we  did  when  he  came  to  us,  and  when  we 
made  him  open  his  eyes,  he  could  not  read  20/30.  We  went  to  work  on 
him  and  found  he  had  over  two  diopters  of  r^rperopia  in  the  meridian  of 


APPENDIX  287 

least  error,  and  one  diopter  more  in  that  of  greatest  error.  We  gave  him 
correcting  lenses,  in  combination  with  baths,  diet,  etc.,  and  he  was  soon 
rid  of  a  case  of  hay  fever  that  had  affected  him  for  twenty  years,  and  which 
the  combined  efforts  of  all  the  doctors  in  medical  school  and  out,  and  all 
the  prescriptions  they  ever  tried  for  it  had  failed.  It  was  the  results  he 
got  himself  from  Ophthalmology  and  Neurology,  and  what  he  saw  others 
getting  friat  induced  him  to  remain  with  us  during  the  past  nine  years,  and 
will  probably  keep  him  with  us.  He  has  developed  himself  into  a  teacher 
who  has  no  superior. 


An  interesting  test  of  the  Neurometric  method  of  practice  is  to  work  it 
backwards ;  that  is,  instead  of  proceeding  as  prescribed  in  the  chapter  on  the 
Neurometer,  in  a  case  of  the  second,  third  or  fourth  classes,  take  first  a  dy- 
namic test  with  naked  eyes,  finding  the  near  point;  then  put  on  a  pair  of 
-(-  3.00  spheres  and  repeat  the  test,  after  which  ask  the  patient's  age.  From 
this  data  it  is  pqssible  to  figure  very  close  to  the  amount  of  the  hyperopia. 
Example :  A  case  showed  by  the  first  test  a  near  point  of  four  inches,  or 
10.00  diopters;  putting  on  -(-  3.00  a  second  test  showed  15.00  D.  power. 
Subtracting  the  +  3.00  left  12.00  D.  actual  accommodative  power;  hence  with 
a  total  of  12.00  and  a  showing  of  only  10.00  at  the  first  test,  2.00  D.  hyperopia 
was  indicated.  Or,  after  finding  the  12.00  D.  which  indicated  on  the 
Xeurometer  15  years,  we  added  for  temperament,  B  4-,  8  years  9  months, 
making  a  total  of  23  years  9  months ;  then  we  asked  the  patient's  age.  He 
said  it  was  29  years ;  we  subtracted  the  23  years  9  months,  which  left  5  years 
3  months.  Referring  to  the  Neurometer  we  found  that  called  for  2.00  D. 
hyperopia.  An  actual  test  of  the  case  approximated  that  amount.  This  is 
not  fitting  a  case  and  proving  it  as  the  regular  method  does,  but  it  is  one  of 
the  most  interesting  experiments  I  have  ever  made. 


Carelessness  is  the  most  common  crime  of  the  human  race.  The  princi- 
ples of  Ophthalmology  forbid  it,  because  it  is  destructive  of  everything  from 
individual  comfort  and  health  to  National  governments.  Professional  work- 
ers, more  than  any  others,  need  to  restrain  themselves  in  this  respect  if  they 
hope  to  succeed.  They  have  to  take  into  consideration  everything  of  which 
the  human  mind  is  susceptible.  To  be  a  good  doctor  one  must  know  con- 
siderable about  every  conceivable  subject,  from  common,  every  day  affairs 
to  the  wildest  prejudices  of  fanatics,  from  the  workings  of  normal  minds  to  the 
vagaries  of  the  sick.  It  is  a  serious  fact  not  to  be  ignored,  that  when 
anyone's  physiology  is  out  of  order  the  mentality  of  that  person  is  in 
at  least  equally  bad  condition  and  must  be  handled  tactfully.  This  can  only 
be  done  by  those  who  are  well-informed  generally,  with  particular  skill  in 
physics,  anatomy,  physiology  and  symptomatology,  and  who  are  well-bred 
and  trained  in  the  amenities. 


In  correcting  cross-eyes  remember  convergent  squint  is  always  a  tonic 
spasm  of  the  most  aggravated  sort  and  pile  on  the  +•  After  getting  all  that 
will  be  accepted  with  normal  vision,  fog  to  20/200.  for  same  time,  and  if 
vision  improves  but  the  eyes  do  not  straighten  put  on  more  +• 


288 


A  SYSTEM  OF  MATURE  MEDICINE 


Clonic  Spasm 
(Normal) 


Neurasthenia 
(Exhaustion) 


Some  Nervous  Exhibits  Caused  by  Nerve  Strain  Through  Hyperopic  Eyes: 

Pain  in  the  eye-balls,  with  large  or  small  pupils,  according  to  the 
amount  of  nervous  tension  in  the  ciliary  region ;  if  it  is  very  tight  the 
current  to  the  iris  may  be  shut  off,  when  the  pupils  will  be  large; 
otherwise  they  will  be  small. 

A  -f-  impulse  by  the   static  test   is  nearly  always   exhibited ;   but,  oc- 
casionally, the  irritation  extends  to  other  nerves   including  the  6th, 
and  the  test  shows  o.  k. ;  however  there  are  always  plenty  of  other 
Tonic  Spasm  symptoms  to  expose  the  fact  of  spasm. 

(Irritation)  Dry,  itchy  eyes;  restricted  accommodation  by  the  dynamic  test;  symp- 

toms of  hyperopia  in  abundance,  but  an  actual  exhibit  of  .50  or 
more  myopia;  conjunctivitis,  ranging  from  simple  irritation  to  so- 
called  "trachoma";  Aleibomian  cysts,  etc. 

Retinitis,  exhibited  by  painful  vision  when  the  ophthalmoscope  shows 
no  congestion  of  the  vessels  of  the  retina. 

Present  in  greater  or  less  degree  in  all  persons  not  totally  presbyopic; 
renders  the  accommodation  more  readily  adjustable  for  all  dis- 
tances ;  in  some  children  is  so  nearly  tonic  that  they  often  conceal 
hyperopia  and  appear  emmetropic,  or  only  a  little  hyperopic,  without 
any  eye  symptoms,  yet  they  will  exhibit  dullness  in  school,  head- 
aches, indigestion,  constipation,  bed-wetting,  convulsions,  mental  ir- 
ritation, without  apparent  cause ;  then  we  go  after  the  eyes  and  fog 
by  the  week  until  we  finally  make  the  hyperopia  manifest;  in  the 
meantime  the  symptoms  will  have  disappeared 

May  exhibit  conjunctivitis  in  any  form;  rarely  any  photophobia,  un- 
less the  case  is  verging  in  the  tonic  stage;  .often  too  free  lachryma- 
tion,  overflowing  on  cheeks ;  intermittent  vision  during  unfogging 
process  from  alternating  cramps  and  relaxation. 

Exhibits  at  any  age  in  any  person  with  unconnected  hyperopia  arid 
accommodation  enough  to  attempt  to  overcome  the  error.  All 
should  be  corrected  in  full  in  order  to  prevent  tonic  spasm  or,  pos- 
sibly, neurasthenia.  Take  plenty  of  time  to  find  and  correct  con- 
tributing causes  by  ordering  hot  baths,  rest  and  proper  food. 

Exhibits  often  as  clonic  spasm  accompanied  by  faintness  and  even 
nausea  on  the  relaxation  turn;  always  —  impulse  by  the  static  test; 
sometimes  an  extra  good  dynamic  test  indicating  a  tonic  tendency, 
hence  a  favorable  prognosis;  usually  a  weak  dynamic  exhibit  and 
report  of  eyes  tiring  when  reading. 

Often  conjunctivitis,  even  to -granulations,  when  the  fright  from  the 
appearance  is  often  a  contributing  cause  of  weakness. 

Women  exhibit  dysmenorrhoea,  amenorrhoea  and  menorrhagia.  Girls 
become  anemic  and  puzzle  general  practitioners  because  they  know- 
nothing  of  the  possibilities  of  hyperopia  as  causative  factors  in  all 
physiological  derangements. 

Take  careful  measurements,  make  indicated  discounts  in  the  Neuro- 
metric  calculations  and  all  such  cases  will  be  found  at  or  below 
their  Safety  Lines.  They  are  Neurological  cases ;  but  may  be  given 
some  help  by  Ophthalmological  procedures. 


Pupil  distances  for  hyperopes  should  be  one  millimeter  shorter  at  each 
end  than  the  actual  measure,  to  insure  comfort.  Myopes  may  wear  full 
length  pupil  distances,  and  even  a  little  more ;  never  less  than  full  length. 


Occasionally  there  will  be  found  a  case  of  amblyopia  from  cloudy 
vitreous  humor,  and  the  patient  will  not  be  able  to  see  better  than  half  way 
down  the  test  card  with  any  lens.  After  getting  the  best  vision  possible  with 
the  strongest  -f-  lenses  acceptable,  make  a  reading  test  at  ordinary  working 
distance;  if  the  patient  is  of  presbyopic  age  it  will  be  found  often,  that  he 
accepts  a  -f-  4.00  or  more  addition  for  reading.  The  true  Ophthalmologist 
knows  this  would  not  be  if  the  full  correction  had  been  found  for  distance ; 
therefore  he  increases  the  distance  lens  the  amount  of  the  difference  between 
the  addition  for  reading  and  the  normal  -f-  3.00. 


APPENDIX  239 

That  our  graduates  have  an  advantage  over  all  other  practitioners  is  a 
long-conceded  fact.  One  of  the  reasons  for  it  is  they  are  taught  principles ; 
another  is  the  Neurometer.  Here  is  a  typical  case,  a  representative  of 
class  2 : 

App.:  Male;  5  ft.  4  in.;  about  110  Ibs. ;  fair;  bright;  sociable. 
His. :  Hard  work  in  store  and  at  jeweler's  bench ;  headaches ;  indigestion. 
Oph. :  Both  arteries  and  veins  in  good  condition  qualitative  and  quantitative ; 

number  of  vessels  normal  average. 

Vis.:  L.  20/30;  R.  20/50;  vertical  lines  on  astigmatic  chart  plainest. 
Dyn. :  7.00  D.,  indicating  30  years  of  age  exactly. 
Stat. :     ^° — ,  indicating  a  slightly  over-taxed  nervous  system. 
Cor.:  L. +2. 50— 1.00  axis  180;  R.-f 2.00— 1.50  axis  180,  which  transposed  is: 

L.+l. 50+1.00  axis  90;  R+50+1.50  axis  90. 
Vis. :  20/30 ;  held  back  because  of  clonic  spasm  exhibiting  during  test.     The 

fact  that  -f  1.50  only  fogged  to  20/200  when  added  to  the  correction, 

gave  evidence  that  his  accommodation  will  settle  and  vision  will  be 

normal  warranted  prescribing  as  the  final  correction. 
Dyn. :  9.00  D.,  shows  an  increase  equal  to  the  error  in  the  fixing  eye,  over 

the  first  test,  making  it  an  average  class  2  case. 
Stat.:  1°  R  H  (right  hyperphoria)  which  will  disappear  with  the  correction; 

it  merely  indicates  an  erratic  nervous  distribution. 

Analysis :     D. 

Dynamic, 

Hyperope 

Temp.  B  —        = 


'0  = 
0- 

Yrs 

:23 
:     5 

:     7 

.  Mos. 
4 
0 
6 

Davs 

o" 

0     Less 
0     Less 

10%  = 

5%  = 

Yrs. 
23 
4 

Mos. 
4 
6 

1 

Days. 
0 
0 
15 

Discounts  : 
App.  Good  1 
His.  Good  1 
Oph.  Good  1 
Dyn.  Good  1 
Stat.  Goad  1 

5: 

H 
S 
D 
T 

35 

31 

27 

10 
8 
6 
4 

0 
0 
0 
n 

Condition= 
Date    of    Ex 
Date    Birth 

34 
1916 
1881 

11 
8 
3 

15 
18 

8 

Age  35          5       10 


Always  be  extremely  cautious  in  using  --  lenses,  because  overcorrection 
of  myopia  causes  artificial  hyperopia  and  strain.  I  have  had  many  cases 
who  had  been  thus  overcorrected  and  were  suffering  bad  results.  One  girl 
came  wearing  —  1.50  and  had  "epilepsy."  I  found  she  was  a  hyperope  of 
1.50  and  the  correction,  with  other  treatment  soon  restored  her  to  health. 
She  never  had  a  seizure  before  she  wore  the  —  lenses. 


Some  oculists  insist  that  no  child  ever  needs  -|-  5.00  or  more ;  that 
such  lenses  are  for  old  people  and  for  near  work.  They  are  optical  fools. 
Many  children  are  hyperopic  as  much  as  8.00  or  even  more  and  if  the  doctois 
knew  anything  at  all  about  ophthalmology  they  would  know  better  than 
to  make  the  assertions  they  do.  I  wear  stronger  glasses  for  distance  than 
my  father  ever  wore  for  near  work,  because  my  eyes  were  deficient  and  his 
were  not.  I  should  have  had  my  lenses  when  a  child  and  I  would  have  been 
much  the  better  for  them.  I  have  worn  my  full  correction  for  over  twenty 
years  and  I  will  never  need  to  change  the  glasses,  because  my  error  is 
corrected  in  full.  I  take  time  enough  to  get  the  full  correction  for  all  of 
my  cases.  That  is  why  I  have  success  where  others  have  failed.  The  reason 
our  graduates  win  is  because  they  know  how  to  get  full  corrections. 


290 


A  SYSTEM  OF  MATURE  MEDICINE 


The  following  was  an  interesting-  case: 

App. :  Male;  just  arrived  at  manhood;  5  ft.  6  in.;  115  Ibs. ;  dark;  well. 
His. :  Good ;  always  been  well. 
Oph. :  Normal. 
Dyn. :  14.00  D. 
Stat. :  O.  K. 

Cor.:  L.+.50— 1.25  axis  90;  R.  Same. 
Vis. :  20/30— O.  U. 
Vis.  :L.  20/50  ;  R.  20/40. 
Dyn. :  14.00  D. 
Stat.  1°+. 


Analysis  :                 Yrs. 
Dynamic,    14.50=    8 
Hyperopia,     .50  =    7 
Temp.  B  -         =7 

Mos.  Days. 
9        0 
6        0     Less    10%  = 
6        0     Less      5%  = 

Yrs. 
8 
6 

7 

Mos.  Davs. 
9        0 
9        0 
1       15 

Discount. 
Aup.  Good  1 
His.  Good  1 
Oph.  Good  1 
Dyn.  Good  1 
Stat.  Good  1 

5 

H 
S 
D 
L 

23 
18 
13 
8 

9 
9 
9 
9 

0 
0 
0 
0 

Condition 
Date  of  Ex 
Date  Birth 

Age 

22 
1916 
1893 

7 
8 
12 

15 
19 
12 

22 

8 

7 

5  =  10% 


There  was  a  question  about  there  being  any  hyperopia,  because  the  - 
cylinders  only  gave  20/20  vision ;  but  the  high  accommodative  power  was 
suspicious,  and  figuring  on  a  basis  of  14.00  D.  dynamic  showing,  with  nothing 
to  add  for  hyperopia,  would  force  us  to  add  over  A  -(-  for  temperament,  and 
people  of  his  class  temperamentally  do  not  require  over  B  or  B  — ,  there- 
for his  case  was  figured  on  the  basis  of  .50  hyperopia  and  came  out  right. 
The  -\-  static  showing1  after  the  test  also  indicated  the  addition  of  -}-  .50 
to  the  cylindrical  correction  which  gave  20/20.  There  is  no  question  about 
his  settling  to  normal  after  wearing  the  glasses  a  month  or  so.  Such  cases 
often  deceive  operators  and  they  get  too  much  - — . 

When  I  wrote  Optical  Truths,  eight  years  ago,  I  made  all  discounts  ac- 
cording to  the  static  test  showings.  Since  that  time  I  have  improved  the 
method  of  analysis,  spreading  the  discounts  over  the  five  items,  appearance, 
history,  ophthalmoscope,  dynamic  and  static  tests.  It  all  amounts  to  the 
same  thing  but  goes  into  greater  detail.  The  chapter  on  the  Neurometer 
explains  it  fully. 


In  apparent  mixed  astigmatism,  when  the  correction  gives  20/20  vision 
with  say  -4-1.00 — 1.50  axis  180,  which,  transposed,  is  — .50+1.50  axis  90,  steal 
the  —  sphere  and  prescribe  the  -f-  cylinders  alone.  It  will  be  found  nearly 
always  that  vision  will  come  to  20/20,  thus  proving  the  mixed  astigmatism 
was  false  and  that  it  is  a  case  of  simple  hyperopic  astigmatism.  Keep  on 
the  safe  side  and  win. 


See  that  all  patients  are  fitted  with  lenses  and  trimmings  or  frames 
that  do  not  mar  their  appearance.  Spectacles  are  far  better  than  eye 
glasses  and  patients  will  never  object  to  them  if  they  are  made  correctly. 
My  patients  all  have  to  wear  spectacles  until  they  are  well ;  then  they  can 
go  to  an  optician  and  get  all  the  style  they  want — but  they  must  not  come  to 
me  with  their  troubles  if  any  result. 


APPENDIX  291 

As  an  illustration  of  how  little  common  sense  is  exhibited  by  optician^ 
and  optical  practitioners  generally,  we  have  the  complaints  of  a  host  on 
account  of  the  hook  temples  on  spectacles  hurting  the  ears.  The  opticians 
have  "invented"  the  "cone"  end  the  "cable"  temple  and  other  devices,  which 
all  failed  for  a  simple  reason — they  were  too  short.  I  discovered  twenty 
years  ago  that  the  very  lightest  weight  gold  temple,  or  any  other  material, 
for  that  matter,  is  sufficient  to  hold  lenses  in  place  on  the  face  if  it  is  long 
enough ;  so  I  always  have  temples  made  long  enough  to  go  so  far  around 
the  ear  that  they  almost  show  the  ends  below  the  ear  to  one  standing  in 
front.  "A  miss  is  as  good  as  a  mile"  said  the  old  soldier  when  the  Indian's 
arrow  just  missed  him ;  and  if  the  ends  do  not  show  that  is  all  right.  My 
patients  never  complain  about  temples  hurting  their  ears. 


If  a  patient  returns,  after  a  few  days  fogging,  complaining  that  the 
lenses  have  made  his  eyes  sore,  and  exhibits  a  pronounced  conjunctivitis, 
explain  that  it  is  not  the  lenses,  because  they  are  absolutely  inert;  but  it 
is  his  own  habit  of  responding  to  circles  of  diffusion  at  his  retina,  caused 
by  his  hyperopia,  by  using  his  accommodation;  show  that  the  circles  are 
now  formed  as  in  myopia,  and  he  must  tell  the  controlling  center  in  the 
brain  to  ignore  the  call ;  have  him  go  home,  use  first  hot  water  applications, 
followed  by  cold  salt-water  instillations  and  a  cold  salt-water-soaked  cloth 
laid  over  the  eyes  while  he  takes  plenty  o£  sleep  and  rest  and  he  will  be 
all  right  in  a  few  days;  his  vision  will  clear  up  and  the  final  correction  will 
be  easy. 

Sometimes  something  very  much  like  seasickness  occurs  during  the  first 
few  days  of  wearing  temporary  corrections ;  and  sometimes,  also,  when  the 
final  corrections  contain  cylinders  with  oblique  axes,  there  will  be  the  same 
exhibits.  Patients  should  be  told  in  advance  of  the  probabilities;  but  be 
assured  that  if  they  stick  to  the  corrections  for  a  week  or  two  they  will  be 
delighted  with  the  results.  It  is  merely  a  temporary  disturbance  of  the  ner- 
vous system  while  it  is  readjusting  itself  to  the  normal  conditions. 

The  public  should  be  frequently  cautioned  against  practitioners  who 
pretend  to  fit  glasses  with  a  mirror  or  a  machine,  either  with  or  without 
atropine.  Not  one  of  those  pretenders  knows  the  first  principles  of  Ophthal- 
mology or  physiology,  or  no  such  claims  would  be  made,  except  through 
dishonesty.  I  have  long  held  open  a  challenge  to  any  of  those  fiends  to 
come  to  my  office  and  fit  me  and  one  other,  to  be  selected  from  the  company 
present,  with  our  true  correction,  for  which  I  will  pay  $500.  Only  one  has 
ever  dared  present  himself;  he  came  with  a  party  of  Illinois  "optometrists'* 
and  they  proved  conclusively  they  had  no  conception  of  the  nervous  system, 
of  corrections,  or  of  anything  else  optical.  One  of  them  contended  that  be- 
cause a  pair  of  -f-  .50  spheres  he  fitted  a  case  with,  which  gave  20/15  vision, 
were  as  good  a  correction  as  -f-  2.00  which  the  person  wore  with  20/20  vision. 
That  fellow  holds  today  a  "license"  from  the  Illinois  "optometry"  board,  one 
of  the  greatest  humbugs  the  politicians  of  Illinois  ever  perpetrated  on  the 
people.  The  other  humbugs  are  other  "practice"  acts. 


292  A  SYSTEM  OF  MATURE  MEDICINE 

The  late  Dr.  Swan  M.  Burnett,  of  Washington,  D.  C,  paid  more  atten- 
tion to  the  study  of  astigmatism*  than  any  other  of  the  old-school  prac- 
titioners. In  his  book,  published  in  1887,  he  gave  statistics  of  475  cases,  950 
eyes,  of  which  he  reported  806  astigmatic.  He  subdivided  them  as  follows: 

Simple  myopic   astigmatism    ., 294  or     37% 

Compound  myopic  astigmatism 162  or     20% 

Simple  hyperopic  astigmatism    210  or     26% 

Compound  hyperopic  astigmatism  113  or     14% 

Mixed    astigmatism    27  or       3% 


Total    806  or  100% 

It  struck  me,  while  reading  the  details  of  his  work  that  he  gave  too 
many  weak  —  cylinders  and  must  have  given  --  when  -f-  were  needed  fre- 
quently. I  took  my  records  along  in  the  latter  '90s  and  found  in  428  con- 
secutive cases,  856  eyes,  that  exactly  50  per  cent,  were  astigmatic,  instead  of 
the  nearly  85  per  cent,  he  claimed.  And  mine,  when  subdivided,  proved 
my  surmise  was  correct.  It  has  been  corroborated  many  times  since.  Mine 
were : 

Simple  myopic  astigmatism 7  or  about 

Compound  myopic  astigmatism   32  or  about 

Simple   hyperopic  astigmatism    44  or  about 

Compound   hyperopic   astigmatism    ....287  or  about  67   % 
Mixed   astigmatism    58  or  about 


Total    428  or  100  % 

Comparing  each  item  in  the  two  records  will  show  that  I  found  hyper- 
opia  where  he  found  myopia.  His  record  shows  57  per  cent,  myopes,  while 
mine  only  shows  9  per  cent.  His  shows  43  per  cent,  hyperopes.  while  mine 
shows  91  per  cent.  I  learned  later  that  he  had  discovered  his  mistake,  and 
appeared  very  proud  of  his  progress,  which  was  certainly  creditable  and  in 
singular  contrast  with  the  majority  of  his  colleagues,  who  persist  in  their 
errors  rather  than  admit  the  possibility  of  erring.  It  has  always  been  our 
policy  to  criticize  ourselves  and  be  sure  we  are  right  before  we  teach  stu- 
dents, who  are  to  go  out  in  the  world  and  represent  our  institution.  Those 
who  revert  to  old  practices  are  unworthy  the  confidence  of  the  public;  but 
happily  few  do  that,  further  than  to  attempt  to  practice  in  stores  where 
they  do  not  have  conditions  conducive  to  the  practice  of  true  Ophthalmology; 
but  even  then  they  do  better  work  than  "optometrists"  and  oculists,  so  far 
as  fitting  glasses  is  concerned. 


The  eyes  are  double  gauges,  for  a  double  purpose:  First,  with  the 
ophthalmoscope  we  learn  the  quality  and  quantity  of  blood,  the  number  and 
calibre  of  the  vessels,  and,  incidentally,  we  note  any  abnormalities  which  may 
be  present  in  the  forms  of  inflammation,  deposits,  etc.  Second,  we  employ 
the  dynamic  and  static  tests  to  ascertain  the  status  of  the  nerve  supply;  with 
our  fixed  standards  we  are  able  to  determine  whether  it  is  normal,  irritated 
or  exhausted.  Irritation  means  general  weakness,  but  a  temperamental 
capacity  for  calling  up  the  last  remnant.  Exhaustion  means  general  weak- 


APPENDIX  293 

ness  with  either  an  incapacity,  temperamentally,  or  such  a  depletion  of  sup- 
ply that  there  is  none  to  call.  Ophthalmology,  as  we  teach  it,  is  a  system 
of  general  practice  by  itself.  It  is  also  an  important  part  of  our  General 
System  of  Mature  Medicine,  which  we  have  named  Neurology,  because 
we  prove  that  all  human  ills  are  nervous  derangements. 


Do  not  forget  that  a  clonic  spasm  may  change  to  tonic,  or  vice  versa,  dur- 
ing the  refraction  test,  even  under  the  best  conditions.  Be  careful  to  do 
nothing,  accidentally  or  otherwise,  to  startle  the  patient's  nervous  system, 
while  working  on  him.  Practice  gentleness  and  skill  in  putting  lenses  in 
the  trial  frame ;  be  quick  but  sure ;  know  what  you  are  doing  and  know  in- 
stantly whether  the  response  to  any  lens  is  what  it  should  be.  I  average 
two  hours  to  each  case,  not  over  fifteen  minutes  to  the  refraction  test  and 
often  less.  If  I  find  a  condition  that  precludes  the  possibility  of  a  reasonably 
good  correction,  I  do  not  waste  time  on  it,  but  find  the  proper  temporary 
lens  which  will  stop  all  excess  nerve  demands  and  put  my  patient  on 
probation,  as  my  friends,  the  Methodists,  do. 


Cycloplegics  are  drugs  which  dilate  the  pupils  and  partially  paralyze 
the  accommodation.  Mydriatics  are  those  which  dilate  the  pupils  but  have 
little  or  no  effect  on  the  accommodation.  Those  commonly  used  by  oculists 
are:  (1),  Atropine,  an  alkaloid  of  atropa-belladonna,  or  deadly  nightshade; 
(2),  Homatropine,  a  product  of  atropine;  (3),  Duboisine,  from  duboisia 
myoporoides ;  (4),  Hyocyamin  or  Scopolamin,  from  scopolia  japonica ;  (5), 
Daturine,  from  daturia  stramonium;  (6),  Gelsemine,  from  gelsemium 
sempervirens;  (7),  Cocaine,  from  erythroxylin  coco;  (8),  a  combination  of 
atropin  and  cocaine ;  all  of  which  are  dangerous  and  of  no  use  whatever  in 
our  system  of  practice,  as  they  would  interfere  with  our  proving  tests.  The 
public  objects  to  having  "drops"  put  in  the  eyes  and  should  be  encouraged 
to  rebel  against  it. 

Our  Ophthalmologists  have  removed  the  causes  of  more  "heart  disease" 
cases  than  all  the  old-school  doctors  in  Christendom  ever  relieved,  or  ever 
will  relieve,  until  they  learn  the  lesson  that  there  is  no  such  thing  as  a  "cure" 
for  anything;  that  strychnine,  digitalis,  nitro-glycerine,  stimulate  heart  action 
only  because  they  irritate  the  nervous  system  as  poisons,  'and  there  is  an  auto- 
matic general  attempt  to  get  rid  of  the  cause.  The  danger  is  that  the  drugs  will 
produce  an  over-exertion  and  consequent  death.  Even  the  doctors  know 
enough  to  quit  administering  strychnine  when  the  "jerks"  appear;  to  let 
up  on  iodides  when  the  eruption  appears,  etc. 


Now  the  serum-vaccine  companies  have  a  new  one.  It  is  called  "Ragweed 
Hay  Fever  Vaccine"  and  is  endorsed  by  the  "regulars.'1  It  reminds  me  of 
a  visitor  I  received  recently,  a  member  of  the  Ohio  State  Medical  Board,  who 
came  over  to  "investigate"  vis.  Among  the  many  questions  he  asked  was : 
"You  appear  to  be  opposed  to  boards  of  examiners,  will  you  tell  me  why? 
Don't  you  believe  the  practice  of  medicine  should  be  regulated?"  That  was 
a  double-barreled  question,  and  I  answered  the  second  query  first,  saying : 
"If  you  mean  the  practice  of  drug  medicine,  I  certainly  believe  it  should  not 


294  A  SYSTEM  OF  MATURE  MEDICINE 

be  'regulated/  I  believe  it  should  be  prohibited,"  and  I  referred  to  the  fact 
that  not  one  doctor  in  a  thousand  knows  anything  about  what  he  prescribes 
most  of  the  time;  he  is  merely  a  distributor  for  chemical  houses.  I  have 
their  catalogues  which  presume  to  tell  the  doctors  what  to  prescribe  for  the 
various  ills,  giving  dosage  and  all  particulars.  Then  I  proceeded  to  show 
him  by  his  own  testimony  what  humbugs  the  laws  are :  First,  he  was  gradu- 
ated from  the  University  of  Pennsylvania  as  a  physician  and  surgeon,  and 
is  licensed  as  such  in  the  state  of  Ohio,  yet  he  admitted  he  is  not  a  surgeon 
and  never  was ;  I  called  attention  to  the  fact  that  in  Ohio  and  other  states  they 
were  forced  to  admit  homeopaths  to  an  examination  according  to  methods 
entirely  different  from  those  of  the  "regulars,"  and,  on  passing,  they  receive 
licenses  the  same  as  "regulars,"  and  they  go  out  and  practice  "regular" 
medicine,  without  any  knowledge  of  it  whatsoever.  He  admitted  I  was 
right,  and  I  asked  him  if  it  was  fair  to  the  public  to  have  such  "laws."  He 
asked  if  we  do  dissecting  in  our  school.  I  replied :  "No,  sir,  that  is  an- 
other humbug."  I  then  called  his  attention  to  the  fact  that  a  couple  of  years 
ago  we  learned  authoritatively  that  Rush  had  only  sixty  cadavers  one  year, 
and  there  were  about  800  students.  He  stopped  me  saying,  "Oh,  let  us  be 
fair,  doctor;  you  know  only  about  a  hundred  or  so  were  in  first  and  second 
year  work."  I  admitted  it,  but  asked  how  much  a  student  could  learn  from 
dissecting  a  part  of  a  cadaver.  I  asked  how  much  dissecting  he  had  done 
while  in  school,  and  he  admitted  a  very  small  part  of  one  body.  I  asked  him 
what  anatomies  are  for.  I  asked  if  a  man,  to  learn  anatomy  by  dissection, 
should  not  spend  years  in  dissection  of  many  bodies.  He  finally  gave  up  and 
agreed  that  as  dissection  is  practiced  in  the  old-schools,  it  is  a  waste  of  time. 
Then  I  called  his  attention  to  the  fool  "law"  in  Ohio  which  attempts  to  give 
the  "regular"  board  power  to  examine  and  grant  licenses  to  those  who 
practice  "other  systems,"  and  states  that  inasmuch  as  "the  members  of  the 
board  are  not  competent  to  examine  the  others,  they  shall  have  power  to 
call  in  some  representatives  of  those  schools,  and  alleged  schools,  to  do  the 
examining  and  passing,"  thus  making  the  board  ridiculous.  I  cited  him 
to  the  fact  that  they  have  already  licensed  by  exemption  nearly  two  thou- 
sand drugless  practitioners  who  had  been  in  practice  and  withstood  perse- 
cution as  criminals  by  the  board.  I  showed  him  if  they  were  criminals  before, 
they  are  now  licensed  criminals,  and  the  state  of  Ohio  is  an  accessory.  T 
showed  him  that  the  examinations  of  their  own  drug  doctors  is  a  farce — a 
hundred  questions  on  sixteen  subjects,  not  enough  to  test  the  competence  or 
prove  the  incompetence  of  anyone.  Our  graduates  have  to  answer  hundreds 
of  questions,  oral  and  written,  in  Ophthalmology  alone,  before  they  can 
graduate  from  that  department.  I  gave  him  details  of  how  we  teach  con- 
secutively, six  hours  a  day,  for  days  at  a  time,  on  a  single  subject,  while 
the  old-schools  have  six  or  more  subjects  a  day  by  as  many  professors.  T 
asserted  that  they  have  not  a  man  in  old-school  work  as  a  teacher  who  could 
take  a  class  for  six  hours  a  day  for  two  weeks  and  get  through  with  it.  be- 
cause none  of  them  have  ever  done  it.  I  informed  him  we  do  that  all  the 
time,  and  have  been  doing  it  for  over  twenty-three  years.  We  had  a  fine 
visit,  Dr.  Upham  is  a  fine  man — in  bad  company,  and  the  bad  business 
of  trying  to  make  criminals  of  competitors — but,  no  doubt,  popular  with  his 


APPENDIX  295 

patients,  and  as  good  a  doctor  as  he  can  be  with  his  training.  We  parted 
good  friends,  and  he  was  liberal  enough  to  say  I  had  enlightened  him.  He 
learned,  among  other  things,  that  we  are  not  fighting  individuals,  except 
as  they  represent  the  Medical  Trust's  System,  that  we  are  fighting  for 
honesty  with  the  public  and  the  freedom  in  competition  which  forces  doctors 
to  educate  themselves  or  drop  out  of  practice.  Later,  referring  to  a  medical 
directory,  I  found  he  is  a  professor  in  the  medical  department  of  the  Ohio 
State  University  Medical  Department,  and  it  is  possible  that  he  will  induce 
his  colleagues  to  introduce  our  rational  methods  of  instructions.  If  he 
does,  Ohio  will  be  a  leader  instead  of  dragging  along  in  the  old  rut. 


My  proposition  has  always  been  that  the  public  is  100,000,000  strong,  and 
that  it  cannot  be  imposed  on  by  any  set  of  150,000  doctors,  or  by  any  small 
number  of  professional  or  tradesmen ;  that  a  doctor's  union  is  worse  than  a 
labor  union;  that  their  tactics  are  the  same,  only  the  labor  men  slug  with 
clubs  and  votes,  while  the  doctor's  do  the  trick  by  "law,"  and  the  public  pays 
the  bill  in  taxes.  The  principles  of  both  are  the  same,  and  all  are  inimical  to 
the  general  welfare.  Education  is  the  only  hope  of  this  country  and  so 
long  as  it  is  controlled  by  men  who  are  orthodox  in  religion,  medicine,  or 
anything  else,  save  Nature  and  Her  laws,  the  education  is  a  fraud  and  detri- 
ment. Those  who  want  to  be  true  to  themselves  will  have  to  be  true  to 
Nature,  and  they  will  have  to  study  hard  to  understand;  then  as  they  learn 
they  will  be  more  tolerant  and  liberal ;  they  will  not  assert  that  because  one 
is  not  in  accord  with  them  he  is  not  honest,  hence  should  be  prohibited 
from  following  his  calling.  I  am  sure  the  world  would  be  far  better  off  if 
Christianity  were  wiped  out,  but  I  would  not  wipe  it  out  of  I  had  the  power  to 
do  it  because  I  would  be  interfering  with  the  inherent  rights  of  others.  I  do 
seek,  in  my  school  and  elsewhere,  to  set  people  thinking,  to  analyzing,  to 
educating  themselves.  I  teach  in  school  that  the  alleged  "Word  of  God"  is 
clearly  deficient  in  that  it  does  not  teach  what  we  teach  and  prove.  This 
book  contains  some  of  Nature's  laws  with  proofs  of  their  importance  and  con- 
stancy, not  one  of  which  can  be  found  in  the  "holy  bible;"  thus  I  believe  I 
prove  that  the  dictator  of  the  bible  is  either  an  ignorant  fraud,  or  he,  she,  or  it, 
was  deliberately  derelict  in  a  duty  toward  mankind.  There  are  plenty  of 
good  Christians  who  would  gladly  see  me  burned  at  the  stake  or  sent  to  the 
penitentiary  for  this  utterance,  which  sentiment  is  further  proof  of  the 
humbuggery  of  bible  "education."  It  breeds  such  unspeakable  creatures  as 
Billy  Sunday  and  his  talks  to  "women  only,"  some  of  which  have  been  re- 
ported to  me,  and  I  marvel  that  he  is  permitted  to  run  at  large ;  not  that  I 
would  punish  him  for  his  insults,  but  he  must  be  dangerously  insane,  dis- 
gustingly lewd  and  overflowing  with  evil  thoughts,  which  would  never 
occur  to  a  Neurologist,  or  any  other  gentleman  or  lady. 


"Diabetic  Foods"  proclaimed  to  be  "starch  and  sugar  free"  are  the  very 
latest  old-school  "proprietary"  article  of  commerce.  Let  no  one  be  deceived. 
Food  is  not  the  only  thing  necessary  for  diabetics,  and  the  foods  advertised 
for  sale  by  promoters  are  not  one-tenth  as  good  as  the  fruits  to  be  had  at 
the  stores  of  any  town,  and  throughout  the  country.  Neurology,  that  is 


A  SYSTEM  OF  MATURE  MEDICINE 


Mature  Medicine,  teaches  how  to  combine  foods  so  that  we  eat  anything  and 
everything;  but  that  alone  would  not  fill  the  bill  of  health.  The  human 
body  has  a  variety  of  departments  which  demand  attention.  They  are  in- 
terdependent and  what  affects  one  involves  all.  We  have  the  only  system  of 
teaching  and  practice  which  covers  all  of  those  departments. 


The  "infantile  paralysis"  scare  is  the  latest  proof  that  old-school  medical 
"science"  is  a  rank  fraud,  on  a  par  with  "Christian  Science."  The  public 
should  know  there  are  Natural  laws,  involving  certain  principles,  one  of 
which  our  great  grandparents  knew  something  about,  but  did  not  have 
facilities  to  follow:  "Keep  your  head  cool,  your  feet  warm  and  your  bowels 
open — you'll  be  all  right."  In  these  days  of  bath  tubs  and  instantaneous 
water  heaters,  there  is  no  need  of  any,  excepting  the  very  poor,  being  even 
exposed  to  the  development  of  troubles  unless  they  deliberately  neglect 
themselves.  It  should  be  noted,  with  reference  to  the  very  poor,  that  as  a 
rule  their  children  are  comparatively  healthy ;  one  reason  for  which  is  they 
are  not  overloaded  with  rich  food,  and  another  is  they  have  plenty  of  out- 
door exercise.  One  of  the  principal  causes  of  closed  bowels  is  the  nervous 
irritation  and  consequent  cramp  from  the  efforts  required  to  overcome 
hyperopia  and  see  well ;  another  is  overloading  the  stomach  and  bowels  with 
foods  which  are  hard  to  digest  and  yield  little  return  for  the  effort.  The 
habits  of  eating  pie  and  other  goodies  everyday  is  exceedingly  bad.  Our 
students  who  live  at  the  college  say  we  have  the  most  attractive  meals  they 
ever  ate,  that  they  are  never  hungry,  but  can  always  eat  with  a  relish,  after 
they  have  been  with  us  a  week.  We  have  pie  not  oftener  than  twice  a  week, 
and  we  serve  it  before  noon  dinner,  instead  of  after.  The  rest  of  the  week 
we  always  have  fruit  for  breakfast  and  frequently  for  supper ;  some  sort  of 
fruit  sauce  at  almost  every  meal ;  well-cooked  meats  for  breakfast  and  dinner, 
with  such  vegetables  as  are  wholesome  and  easily  digested.  We  have  big 
breakfasts,  good  dinners  and  light  suppers,  thus  giving  the  digestive  tract 
reasonable  time  for  rest,  and  never  send  it  to  bed  loaded. 


In  cases  of  emergency,  when  there  is  fever,  pain  or  any  other  evidence 
of  nervous  derangement,  even  hysteria,  melancholy,  etc.,  and  in  chronic  cases 
of  "diabetes,"  "rheumatism,"  "epilepsy,"  we  use  the  hot  bath,  followed  by 
rest  in  bed,  to  restore  proper  balance  to  the  nervous  system,  increase  the 
caliber  and  distribution  of  the  lymphatic  and  blood  vessels,  massage  gen- 
erally and  specially,  and  feed  at  least  a  gallon  of  fruit  juices  daily.  When 
the  bowels  are  clogged  anyone  can  get  a  bottle  of  citrate  of  magnesia,  a 
carbonated  water,  at  the  nearest  soda  fountain,  and  be  cleaned  out  in  a  few 
hours.  It  should  be  borne  in  mind,  however,  that  this  information  does  not 
warrant  anyone  in  forming  the  magnesia  habit,  any  more  than  they  would 
form  the  castor  oil  habit,  the  salt  habit,  the  epsom  salts  habit  or  the  liquor 
habit.  We  only  use  purgatives  in  emergencies,  as  we  do  surgery,  and  we 
employ  only  those  elements  which  are  compatible  with  body  chemistry. 
We  teach  people  to  learn  what  gets  them  into  trouble  that  they  may  avoid 
it  in  future.  We  seek  to  impress  upon  all  that  it  is  a  duty  they  owe  Nature 


APPENDIX  297 

to  learn  Her  ways  and  conform  to  them,  if  they  would  be  comfortable,  happy 
and  live  long. 

Accommodation,  as  used  ophthalmologically,  means  the  adjustment  of 
the  dioptric  system  of  the  eye  to  various  points  at  different  distances.  It  is 
double-acting,  that  is,  it  acts  positively  as  the  objective  point  nears  the  face 
and  negatively  as  that  point  recedes.  In  emmetropia  it  is  relaxed  almost  en- 
tirely for  distant  points,  the  amount  required  at  six  meters,  the  ordinary 

testing  distance,  being  only  one-sixth  of  a  diopter  and  for  one  mile  only   - 

1584 

of  a  diopter.  When  the  accommodation  is  entirely  at  rest  the  eyes  are  in 
their  static,  or  natural  condition.  They  are  then  said  to  be  adapted  to  their 
far  points.  When  accommodating  to  their  fullest  capacity,  they  are  adjusted 
to  their  near  points.  As  a  matter  of  fact  the  myopic  eye  is  the  only  one 
which  has  a  far  point,  because  that  is  the  only  condition  in  which  rays  start- 
ing from  the  retina  divergent  will  be  rendered  convergent  by  the  dioptric 
system  so  that  they  me-et  at  a  point  some  distance  from  the  eye.  In  em- 
metropia such  rays  are  rendered  parallel  by  the  dioptric  system ;  and  in 
hyperopia  they  are  still  divergent  as  they  leave  the  eye.  In  emmetropia  the 
total  amount  of  accommodation  is  registered  in  locating  the  near  point,  and 
the  amount,  expressed  in  diopters,  is  the  amplitude  of  accommodation.  In 
hypermetropia  and  myopia  the  errors  must  be  corrected  before  the  test  shows 
the  amplitude ;  and  in  cases  of  hyperopia  in  class  one,  under  approximately 
twenty  years,  the  test  with  the  naked  eye,  expressed  in  diopters  and  the 
power  of  the  -f-  sphere  in  the  correction  added  indicates  the  amplitude  when 
the  second  test  does  not  exceed  their  sum.  This  is  because  a  hyperope  has 
to  overcome  his  hyperopia  before  he  can  begin  to  show  his  near  point,  and 
as  such  people  often  show  more  accommodation  at  the  first  test  than  they 
do  with  the  correction  on  we  take  the  first  test,  plus  the  power  of  lens  when 
the  second  test  does  not  show  more  than  the  calculation  does. 


After  stages  of  spasm  have  developed,  first,  clonic,  then  tonic,  then 
clonic  again,  there  often  follows,  or  rather  is  associated  with  the  last  stage, 
what  is  known  among  oculists  as  asthenopia,  but  it  is  really  a  pronounced 
symptom  of  neurasthenia.  It  exhibits  somewhat  similarly  to  clonic  spasm 
durtng  the  refraction  test,  with  the  difference  that  while  vision  is  changeable, 
pretty  good  one  minute  and  not  so  good  the  next ;  it  fades  away  on  the  down 
turn,,  so  that  sometimes  the  entire  card  becomes  blurred.  This  is  from  two 
causes :  First,  intermittent  action  of  the  accommodation ;  second,  an  inter- 
mittent current  to  the  retina;  thus  indicating  that  both  motor  and  sensory 
nerve  supplies  are  deficient,  and  there  ,is  frequently  nausea,  or  other  un- 
pleasant symptoms  associated.  In  such  cases  we  give  temporary  lenses,  but 
we  permit  better  vision  with  them  than  we  do  in  cases  where  we  are  fogging 
to  break  down  the  tonic  spasm.  The  reason  for  this  is  that  we  know  we 
have  no  latent  error  concealed  by  the  accommodation,  as  we  have  in  the 
case  of  the  tonic  <:pasm,  hence  there  is  no  necessity  for  inconveniencing  a 
patient  by  fogging. 


When  we  make  our  static  test  with  the  double  prism  and  colored  glass, 


298  A  SYSTEM  OF  MATURE  MEDICINE 

if  the  colored  glass  is  on  the  right  eye,  and  the  colored  light  is  seen  at  the 
left,  we  know  we  have  a  tonic  spasm  always,  and  if,  after  the  refraction  test 
a  repetition  of  the  static  test  still  discloses  the  colored  light  to  the  left,  we 
know  we  still  have  the  tonic  spasm  concealing  a  portion  of  the  error.  If 
the  colored  light  is  seen  at  the  right,  it  indicates  not  exactly  the  reverse 
of  tonic  spasm,  but  it  proves  that  if  there  is  a  tonic  spasm,  it  is  only  inter- 
mittently so.  Sometimes  the  dynamic  test  shows  a  high  power  of  accom- 
modation according  to  the  neurometer  tables,  and  that  means  at  least  a 
strong  clonic  spasm ;  but  often  in  such  cases  the  static  test  will  show  nega- 
tively, that  is,  the  colored  light  will  be  at  the  right,  which  tells  us  that  the 
patient  is  of  pretty  high  temperament,  hence  this  becomes  one  of  our  tests 
for  temperament.  If  the  static  test  in  such  a  case  shows  the  colored  light 
to  the  left,  it  means  a  tonic  spasm.  If  the  dynamic  test  shows  a  registration 
weaker  than  indicated  by  the  neurometer  age  and  accommodation  tables,  and 
the  static  test  shows  the  colored  light  at  the  right,  both  tests  indicate  weak- 
ness; but  if  the  static  test  shows  the  colored  light  at  the  left,  it  proves  a 
tonic  spasm,  and  that  it  is  so  intense,  the  accommodation  is  in  a  state  of 
cramp,  which  prevents  either  increase  or  decrease.  Nearly  all  such  cases 
exhibit  intense  pains  in  the  eyes. 


In  making  Neurornetric  calculations  never  add  anything  to  the  age  for 
myopia ;  it  never  overdevelops  the  accommodation. 


The  best  that  can  be  done  in  a  book  is  to  tell  what  is  told  in  the  simplest 
language.  Some  people  only  heed  books  and  doctors  they  cannot  com- 
prehend. This  book  is  not  for  them.  It  is  for  those  who  know  that  only  a 
small  portion  of  a  great  system  can  be  given  in  books,  and  it  has  been  writ-- 
ten with  a  view  to  giving  so  much  information  that  the  reader  will  have  a 
higher  respect  for  the  work  we  must  be  able  to  do  in  the  McCormick  Medical 
College,  and  in  the  hope  that  we  shall  meet  in  closer  relationship  in  the  col- 
lege. 


EPONYMES  —  OPHTHALMOLOGY 

Argyle  Robertson's  Pupil:  Failure  of  pupillary  action  to  light;  it  will 
act  with  accommodation,  however;  supposed  to  be  a  symptom  of  locomotor 
ataxia,  or  "tabes  dorsalis." 

Aubert's  Phenomenon :  An  alleged  optical  illusion  by  which,  when  the 
head  is  inclined  to  one  side,  a  vertical  line  appears  oblique  toward  the  op- 
posite side. 

Baillarger's  Sign:  pupillary  inequality  in  paralytic  dementia.    (?). 

Ballet's  Sign:  Ophthalmoplegia  externa:  loss  of  movement  of  the  eye- 
balls, with  preservation  of  automatic  movements  and  integrity  of  the  move- 
ments of  the  pupils ;  seen  in  hysteria  and  exophthalmic  goitre.  ( ?) 

Bard's  Sign :  To  differentiate  between  organic  and  congenital  nystag- 
mus :  In  the  former  the  oscillations  of  the  eyeballs  increase  when  the 
patient  follows  the  finger  moved  back  and  forth  before  his  face,  from  left  to 
right;  in  the  latter  the  oscillations  disappear  under  these  conditions.  (?). 

Basedow's  Disease :     Exophthalmic  goitre.     See  Graves'  Disease. 

Bell's  Phenomenon:  Upward  and  outward  rolling  of  the  eyeball  when 
an  attempt  is  made  to  close  the  eye  of  the  affected  side  in  peripheral  facial 
paralysis. 

Beraud's  Valve :  A  fold  of  mucous  membrane  found  occasionally  in 
the  lacrimal  sac,  which  it  separates  from  the  nasal  duct.  See  Bochdalek's 
Valve. 

Bitot's  Spots :  Xerosis  conjunctiva ;  silver  gray,  shiny,  triangular  spots 
on  both  sides  of  the  cornea,  within  the  region  of  the  palpebral  aperture  con- 
sisting of  dried  epithelium. 

Blessig's  Groove :  The  slight  groove  in  the  embryonic  eye  that  marks 
the  fundus  of  the  optic  cup  from  the  zone  that  surrounds  the  periphery  of 
the  lens  and  corresponds  to  the  ora  serrata. 

Bochdalek's  Valve :    Same  as  Beraud's  Valve. 

Bogrow's  Fibers :  A  tract  of  nerve  fibers  passing  from  the  optic  tract 
to  the  optic  thalamus. 

Bonnet's  Capsule :     See  Tenon's  Capsule. 

Bowman's  Membrane :  The  anterior  elastic  lamina  of  the  cornea.  B's 
Muscle :  The  ciliary  muscle.  B's  Probe :  For  dilating  the  nasal  duct.  B's 
Tubes :  Artificial  tubes  formed  between  the  lamellae  of  the  cornea  by  the  in- 
jection of  air  or  colored  fluid. 

Bozzi's  Foramen :    See  Soemmerring's  yellow  spot. 

Bright's    Blindness:    Partial    or   complete    loss   of    sight,    temporary   or 


300  A  SYSTEM  OF  MATURE  MEDICINE 

permanent,  without  perceptible  retinal  changes ;  sometimes  seen  in  urenia. 

Browne's  Sign :  Tremor  of  the  outer  angles  of  the  eyes  in  the  early 
stages  of  paralytic  dementia.  (?). 

Bruch's  Glands:  Lymph  follicles  found  in  the  conjunctiva  about  the  in- 
ner canthus.  B's  Layer :  The  lamina  basalis  which  forms  the  inner  boun- 
dary of  the  choroid. 

Bruecke's  Muscle :  See  Bowman's  Muscle.  B's  Tunica  Nervea :  The 
layers  of  the  retina  exclusive  of  the  rods  and  cones. 

Burns'  Amaurosis :     Postmarital  amblyopia  caused  by  sexual  excess.. 

Charcot's  Sign :  In  facial  paralysis  the  eyebrow  is  raised,  in  facial  con- 
tracture  it  is  lowered. 

Cheyne's  Nystagmus :  The  oscillations  of  the  eyeballs  have  a  rhythmic 
variation  similar  to  the  rhythm  of  Cheyne-Stokes'  respiration. 

Cloquet's  Canal :     The  hyaloid  canal,  which  exists  during  foetal  life. 

Davidsohn's  Sign :  The  illumination  of  the  pupil  obtained  on  placing 
an  electrid  light  in  the  mouth  will  be  less  marked  on  the  side  on  which  there 
is  a  tumor  of  the  antrufn  of  Highmore. 

Decemet's  Membrane :    The  posterior  elastic  lamina  of  the  cornea. 

Bonder's  Glaucoma :  Simple  atrophic  glaucoma.  D's  Law :  The  ro- 
tation of  the  eyeball  about  the  line  of  sight  is  involuntary.  D's  Rings : 
Rainbow-colored  rings  seen  in  cases  of  glaucoma  and  by  normal  and  cat- 
aractous  eyes  when  the  pupil  is  dilated. 

Ferrein's  Canal :  A  triangular  channel  supposed  to  exist  between  the 
free  edges  of  the  eyelids  when  they  are  closed  to  serve  for  conducting  the 
tears  toward  the  lacrimal  canals  when  asleep. 

Foerster's  Shifting  Type :  Variations  in  the  visual  field,  the  limits  of 
which  differ  according  as  they  are  determined  by  moving  the  disc  from  the 
center  outwards  or  from  without  toward  the  center :  they  are  seen  in 
traumatic  neuroses. 

Fraunhofer's  Lines :    Black  lines  in  the  solar  spectrum. 

Friedman's  Vasomotor  Symptom-complex;  Ophthalmoplegia  and  my- 
driasis  following  injuries  to  the  head. 

Fuch's  Coloboma :  A  small  crescentic  defect  of  the  choroid  at  the  lower 
border  of  the  optic  disc.  F's  Optic  Atrophy :  Peripheral  atrophy  of  the 
bundles  composing  the  optic  nerve. 

Garel's  Sign :  Luminous  preception  by  the  eye  of  the  sound  side  only 
when  an  electric  light  is  placed  in  the  buccal  cavity.  See  Davidsohn's  Sign. 

Gower's  Symptom :  Intermittent  and  abrupt  oscillations  of  the  iris  un- 
der the  influence  of  light. 

Von  Graefe's  Disease :  Progressive  ophthalmoplegia.  Von  G's  sign : 
Inability  of  the  upper  eyelid  to  follow  the  downward  movement  of  the  eye- 
ball ;  seen  in  goitre.  Von  G's  Spots :  Certain  spots  near  the  supra  orbital 
foramen  or  over  the  vertebrae,  which  when  pressed  upon,  cause  a  sudden 
relaxation  of  the  spasm  of  the  eyelids  in  cases  of  blepharofacial  spasm. 

Gratiolet's  Optic  Radiation :  Fibres  that  pass  from  the  optic  center  in 
the  occipital  lobe  to  the  pulvinar  and  external  geniculate  body. 

Graves'  Disease :     Exophthalmic  goitre.     See  Basedow's  disease. 


EPONYMES — OPHTHALMOLOGY  301 

Gunn's  Dots :  Brilliant  white  dots  seen  on  oblique  illumination,  about  the 
macula  lutea;  they  do  not  seem  to  be  pathologic.  (?). 

Haab's  Pupil  Reflex:  If  a  bright  object  already  present  in  the  field 
of  vision  be  looked  at,  the  pupils  contract,  while  there  is  no  appreciable 
change  during  convergence  or  accommodation.  This  points  to  a  cortical 
lesion. 

Harderian  Gland :  A  racemose  gland  located  at  the  inner  canthus  of 
the  eye  of  most  vertebrates,  particularly  those  having  a  well  developed 
nictitating  membrane. 

Helmholtz'  Theory  of  Accommodation :  In  the  act  of  accommodation  the 
relaxation  of  the  zonula  is  effected  by  the  contraction  of  the  ciliary  muscle, 
and  the  elasticity  of  the  lens.  It  is  the  annular  layer  of  fibers  of  Muller's 
portion  that  is  mainly  of  account  in  accomplishing  this.  When  this  fibre 
layer  contracts  it  lessens  the  size  of  the  circle  formed  by  the  ciliary  processes 
by  approximating  their  apices  to  the  border  of  the  lens.  In  this  way  the 
space  between  the  ciliary  body  and  lens,  that  is  bridged  over  by  the  fibres  of 
the  zonula,  is  contracted  and  the  zonular  fibres  themselves  are  relaxed.  See 
Tscherning  and  McCormick. 

Hering's  Law :  The  distinctness  or  purity  of  any  sensation  or  con- 
ception depends  upon  the  proportion  existing  between  their  intensity  and 
the  sum  total  of  the  intensities  of  all  simultaneous  sensations  and  concep- 
tions. H's  Test :  If,  on  looking  with  both  eyes  through  a  tube  blackened 
inside  and  having  a  thread  across  one  end,  a  small  round  object  be  dropped 
immediately  in  front  of  or  behind  the  thread,  a  subject  with  binocular  vision 
can  at  once  tell  whether  it  has  fallen  nearer  to  his  eyes  or  farther  away.  H's 
Theory  of  Color-Sensation :  Predicates  assimilation  and  disassimilation  of 
the  visual  substance  in  vision-white,  red  and  yellow  representing  disassimila- 
tion, and  black,  green  and  blue,  assimilation. 

Hirschberg's  Test:  A  rough  estimate  of  the  amount  of  strabismus  is 
made  by  observing  the  position  of  the  corneal  reflection  of  a  candle  flame 
held  one  foot  in  front  of  the  eye  to  be  tested,  the  examiner  placing  his  own 
eye  near  the  candle  and  looking  over  it. 

Holmgren's  Test:  The  testing  of  color  sense  by  matching  yarns. 

Horner's  Disease :  A  slight  ptosis  accompanied  by  myosis,  retraction 
of  the  eyeball  and  flushing  of  the  face  in  destructive  lesions  of  the  cervical 
sympathetic. 

Jacob's  Membrane :    The  layer  of  rods  and  cones  in  the  retina. 

Jeffrey's  Symptom :  Absence  of  facial  contraction  when  the  patient  sud- 
denly turns  his  eyes  upward ;  in  exophthalmic  goitre. 

Krause's  Glands :  Acinous  glands  found  in  the  conjunctiva  near  the 
fornix,  especially  of  the  upper  lid. 

Kuhnt's  Spaces :  The  recesses  of  the  posterior  chamber ;  a  series  of 
radial  spaces  which  communicate  anteriorly  with  the  posterior  chamber  of 
the  eye  and  contain  aqueous  humor. 

Landolt's  Bodies :  Small,  elongated  bodies  lying  between  the  rods  and 
cones  and  resting  upon  the  outer  nuclear  layer  of  the  retina.  (?). 

Lauth's  Canal :    See  Schlemm's  Canal. 


302  A  SYSTEM  OF  MATURE  MEDICINE 

Leber's  Disease :  Hereditary  optic  atrophy.  L's  Plexus :  A  plexus  of 
venules  in  front  of  Schlemm's  Canal,  with  which  it  communicates. 

Listing's  Law:  When  the  line  of  sight  passes  from  its  primary  position 
into  any  other  position,  the  angle  of  rotation  of  the  eyeball  in  this  second 
position  is  the  same  as  if  the  eyeball  had  been  rotated  about  a  fixed  axis, 
perpendicular  to  both  the  first  and  second  directions  of  the  line  of  sight.  L's 
Plane :  the  vertical  transverse  plane  perpendicular  to  the  antero-posterior 
axis  of  the  eyeball,  which  passes  through  the  center  of  motion  of  the  eyes  and 
in  which  lie  the  vertical  and  transverse  axes  of  normal  voluntary  rotation. 

Lockwood's  Ligament :  The  suspensory  ligament  of  the  eyeball,  a 
curved  fibrous  band  connected  with  Tenon's  Capsule  and  supporting  the 
eyeball  on  each  side  of  the  orbit. 

Loewe's  Ring:  A  bright  circle  which  appears  in  the  visual  field  when 
the  illumination  is  changed  from  blue  to  white.  It  surrounds  the  position 
of  the  dark  ring  that  marks  the  macula  lutea. 

Manz's  Glands :  Utricular  glands  found  in  the  orbital  conjunctiva  near 
the  margin  of  the  cornea. 

Marie's  Symptom :  Tremor  of  the  extremities  or  of  the  whole  body  in 
exophthalmic  goitre. 

Martegiani's  Area:  The  slight  widening  of  the  hyaloid  canal  at  its  be- 
ginning in  front  of  the  optic  disc.  (?). 

McCormick's  Laws:  (1),  The  two  principal  meridians  of  all  regular, 
nonspherical  curved  surfaces  are  always  at  right  angles  to  each  other.  (2), 
In  heterophoria  the  eyes  are  both  equally  involved  and  the  deviation,  under 
the  test,  is  in  the  same  direction  the  lights  appear.  (3),  Strabismus  always 
involves  both  eyes  and  is  due  to  nervous  irritation  or  exhaustion,  hence  cut- 
ting muscles  is  a  crime.  (4),  The  employment  of  prisms  as  therapeutic 
agents  is  almost  as  wicked  as  operations,  because  the  best  possible  prism 
only  does  one-fourth  as  much  good  as  can  be  done  with  proper  lenses.  (5), 
The  Neurometer  is  a  mathematical  means  of  analysis  of  patients'  conditions. 
(6),  The  inorganic  salts  of  the  body  can  only  be  replenished  by  a  proper 
combination  of  mental  and  physiological  rest,  select  diet,  baths,  manipula- 
tion. (7),  111  health  is  the  natural  result  of  wrong  living — this  applies  equally 
to  the  mentality  and  the  physiology.  (8),  The  "grafter"  digs  the  pit  into 
which  he  eventually  falls. 

McCormick's  Explanation  of  Accommodation :  Nature  has  nowhere  else 
displayed  Her  ingenuity  to  greater  advantage  than  in  the  apparatus  of  ac- 
commodation in  the  eye :  The  suspensory  ligaments,  the  nbro-elastic  struc- 
ture which  holds  the  lens  in  position,  is  antagonized  by  the  circular  fibres 
at  its  lenticular  edge,  comprised  in  the  Canal  of  Petit  and  zonule  of  Zinn,  so 
that  a  comparatively  slight  effort  on  the  part  of  the  ciliary  sphincter  muscles, 
interwoven  with  the  suspensories  and  operated  by  the  third  nerves,  stretches 
the  ligaments  and  causes  expansion  of  the  lens  antero-posteriorly  by  con- 
tracting its  edge.  Proof  .that  the  surrounding  canal  has  much  to  do  with 
accommodation  is  afforded  by  the  facts  that  loss  of  that  power  in  illness  of 
youth  is  only  temporary,  returning  with  health  and  plenty  of  nerve  supply, 
while  in  the  "presbyopia"  incident  to  age,  even  in  health,  when  the  nerve 
supply  is  excellent,  the  loss  is  permanent  but  develops  gradually,  showing 


EPONYMES — 'OPHTHALMOLOGY  303 

that  it  is  due  to  loss  of  elasticity  in  the  canal,  not  to  a  "stiffening  of  the 
ligaments,"  because  extreme  mental  or  physiological  irritation,  when  an  ex- 
cess of  nervous  force  is  turned  on,  enables  the  "presbyope"  to  exhibit  some 
accommodation  momentarily.  See  Helmholtz  and  Tscherning. 

McCormick's  theory  of  color-sensation  is  that  of  chemical  reactions 
caused  by  rays  from  colored  objects  producing  positive  impressions,  followed 
by  the  negative  exhibit  of  a  complementary  color,  one  of  four:  red,  yellow, 
green  or  blue,  the  primary  colors.  It  is  a  test  for  color-blindness  and  a  means 
for  color  education. 

McCormick's  Fogging  System  of  fitting  glasses,  without  cycloplegia, 
thus  permitting  proving  the  work  by  dynamic  and  static  tests. 

Meibomiari  Calculus :  The  hardened  secretion  of  the  Meibomian  glands 
that  may  accumulate  on  the  inner  surface  of  the  eyelids.  M  Cyst  or  Tumor. 
A  chalazion. 

Moebius'  Disease :  Periodic  or  recurrent  paralysis  of  the  motor  oculi. 
M's  Sign :  Inability  to  retain  the  eyeballs  in  convergence  in  exophthalmic 
goitre. 

Moll's  Glands:  Modified  sudoriparous  glands  of  the  eyelids,  opening 
into  the  follicles  of  the  eyelashes. 

Morgagni's  Cataract :  Senile  cataract  in  which  the  nucleus  remains  hard, 
while  the  portion  between  it  and  the  cortex  liquefies. 

Mueller's  Muscles:  (1),  The  circular  bundles  of  muscular  fibres  which 
form  part  of  the  ciliary  muscle  and  are  situated  nearest  to  the  iris.  (2), 
The  superior  palpebral  muscle. 

Nettleship's  Dots :  Minute  white  dots  in  considerable  numbers  between 
the  macula  and  periphery  of  the  retina,  associated  with  pigment  changes  and 
night  blindness ;  may  occur  in  several  members  of  the  same  family. 

Newton's  Color  Rings :  The  colorings  produced  when  a  cover  glass  is 
pressed  upon  a  slide ;  result  of  chromatic  aberration. 

Nicols'  Prism :  A  prism  of  Iceland  spar  that  has  the  property  of  reflect- 
ing the  ordinary  ray  of  light  out  of  the  field,  while  the  so-called  polarized  ray 
is  transmitted. 

Parinaud's  Conjunctivitis:  A  form  of  conjunctivitis  due  to  infection 
from  animals.  P's  Ophthalmoplegia :  A  paralysis  of  the  external  rectus  of 
one  side,  and  spasm  of  the  internal  rectus  of  the  other  side ;  it  is  of  peripheral 
origin.  (?). 

Parrot's  Sign :  Dilation  of  the  pupil  when  the  skin  is  pinched ;  noted  in 
meningitis. 

Parry's  Disease :     See  Basedow's  Disease. 

Parson's  Disease :     See  Basedow's  Disease. 

Petit's  Canal :  The  circular  lymph  space  formed  by  the  separation  of 
the  suspensory  ligaments  of  the  crystalline  lens. 

Placido's  Disc:  A  keratascope  composed  of  a  disc  with  concentric 
circles. 

Purkinje's  Images:  Three  images  of  a  candle  flame  obtained  by  re- 
flection from  the  cornea  and  the  anterior  and  posterior  surfaces  of  the 
crystalline  lens,  the  third  image  being  inverted,  because  of  the  concave  sur- 
face presented. 


304  A  SYSTEM  OF  MATURE  MEDICINE 

Ritter's  Law:  Stimulation  of  a  nerve  occurs  both  at  the  moment  of 
closing  and  of  opening  the  electric  current. 

Sanson's  Images:    See  Purkinje's  Images. 

Sauvineau's  Ophthalmoplegia :  Paralysis  of  the  internal  rectus  muscle 
of  one  side  and  spasm  of  the  external  rectus  of  the  opposite  side.  This 
affection  is  the  reverse  of  Parinaud's  Ophthalmoplegia.  (?). 

Schacher's  Ganglion :    The  ophthalmic  ganglion. 

Schueller's  Sign :  Vertical  folds  between  the  eyebrows,  frequently  seen 
in  subjects  of  melancholia.  (Means  hyperopia). 

Snell's  Laws:  (1),  The  sine  of  the  incident  angle  bears  a  fixed  ratio  to 
the  sine  of  the  angle  of  refraction  for  the  same  two  media,  the  ratio  varying 
with  the  media.  (2),  The  incident  and  the  refracted  ray  are  in  the  same 
plane,  which  is  perpendicular  to  the  surface  separating  the  two  media. 

Soemmering's  Crystalline  Swelling :  An  annular  swelling  formed  in  the 
lower  part  of  the  capsule,  behind  the  iris,  after  extraction  of  the  crystalline 
lens.  S's  Ligament:  The  suspensory  ligament  of  the  lacrimal  gland.  S's 
Yellow  Spot.  The  macula  lutea  of  the  retina.  (This  is  imaginary). 

Stokes'  Disease:    See  Basedow's  Disease. 

Sturm's  Focal  Interval :  The  interval  between  the  focal  points  of  the 
two  principal  meridians  of  a  compound  dioptric  system. 

Talbot's  Law :  When  the  visual  stimuli  proceeding  from  a  revolving 
disc  are  completely  fused  and  the  sensation  is  uniform,  the  intensity  is  the 
same  as  that  which  would  occur  if  the  same  amount  of  light  were  spread 
uniformly  over  the  disc. 

Tay's  Choroiditis :  Choroiditis  guttata  senilis.  A  choroidal  degeneration 
characterized  by  irregular  yellowish  spots  visible  around  the  macula  and 
thought  to  be  due  to  an  atheromatous  condition  of  the  arteries. 

Tenon's  Capsule :  The  orbito-ocular  fascia.  T's  Space :  The  lymph 
space  existing  between  the  sclerotic  and  Tenon's  Capsule. 

Tiedmann's  Nerve :  A  plexus  of  delicate  nerve  fibres  derived  from  the 
ciliary  nerves  and  surrounding  the  central  artery  of  the  retina. 

Tscherning's  Theory  of  Accommodation :  Contraction  of  the  ciliary 
muscle  causes  a  tightening,  not  a  relaxation,  of  the  zonula;  consequently  the 
bulging  of  the  lens  in  accommodation  is  produced  by  an  active  compression 
instead  of  a  passive  dilation.  See  Helmholtz  and  McCormick. 

Verga's  Lacrimal  Groove :  A  more  or  less  pronounced  groove  extending 
downward  from  the  lower  orifice  of  the  nasal  duct. 

Young-Helmholtz  Theory  of  Color  Sensation :  The  doctrine  that  there 
are  three  kinds  of  nerve  elements  corresponding  to  three  primary  colors. 
Stimulation  of  the  first  develops  red;  the  second  green,  the  third,  violet. 
Zinn's  Artery:  The  central  artery  of  the  retina.  Z's  Circle:  The  plexus 
formed  by  small  branches  of  the  ciliary  arteries  within  the  fibrous  layer  of 
the  sclera  around  optic  nerve  entrance.  Z's  Ligament,  or  Ring,  or  Tendon : 
The  circular  fibrous  sheath  formed  by  the  common  tendon  of  the  internal, 
external  and  inferior  rectus  muscles.  Z's  Circle  or  Zonula  Ciliaris :  The 
inner  edge  of  the  suspensory  apparatus  of  the  crystalline  lens. 

Zoellner's  Lines :  A  device  to  illustrate  false  estimates  of  direction 
or  parallelism  by  intersecting  lines  crossing  parallel  lines  at  a  certain  angle. 


GLOSSARY 


AOaxial.  Not  situated  in  the  line  of  the 
axis. 

Abducens.  Leading  away.  External  recti 
and  sixth  nerves. 

Abduct.  To  draw  away  from  the  median 
line. 

Aberration.  To  wander.  Deviation  from 
normal. 

Ablatio  retinae.    Detachment  of  the  retina. 

Ablepharon.     Absence  of  the  eyelids. 

Ablepsia.     Blindness,  or  dim  vision. 

Accommodation.  To  adjust  the  eyes  to  near 
points. 

Achromatic.    Without  color. 

Achromatopsia.  Inability  to  distinguish  col- 
ors. 

Achromia.    Albinism. 

Acorea.  Absence  of  the  pupil. 

Acritochromacy.     Color-blindness. 

Actinic.     A  ray.    Refers  to  violet  rays. 

Actinism.    The  chemic  quality  of  light. 

Acuity.    Clearness.    Refers  to  vision. 

Adducens.  To  bring  toward.  The  internal 
recti. 

Adduction.  To  bring  toward.  Convergence 
of  optic  axes. 

Adenoma.     An  epithelial  tumor. 

Adenophthalmia.  Inflammation  of  the  Mei- 
bomian  glands. 

Adenoma.     A  glandular  tumor. 

Afferent.  Carrying  to.  Nerve  current  to- 
ward brain. 

Afferentia,  (Vasa  afferentia).  Any  vessels 
carrying  blood  or  lymph  to  an  organ. 

Albinism.  Absence  of  pigmentum  nigrum  or 
coloring  matter  of  the  body.  Achromia. 

Albino.    A  person  affected  with  albinism. 

Albuginea.  The  sclerotic  coat  of  the  eye,  an- 
teriorly. 

Albugo.     Clouding  of  the  cornea. 

Alexia.     Word  blindness. 

Amaurosis.     Blindness. 

Amblyopia.    Dimness  of  vision. 

Amenorrhea.    Absence  of  menstruation. 

Ametrometer.  An  instrument  to  measure 
ametropia. 

Ametropia.  Any  refractive  defect  of  the 
eyes. 

Ametropic.  Affected  with  or  pertaining  to 
ametropia. 

Amianthinopsy.     Violet-blindness. 

Ampulla.  Trumpet-mouthed,  as  the  dilated 
extremity  of  the  lachrymal  canal. 

Amyloid.    Starch-like. 

Analepsia.  Recovery  of  strength  after  sick- 
ness. 

Anastomosis.  Intercommunications  of  blood 
vessels. 

Anemia.     Deficiency  of  blood. 


Aneurysm.  A  wart-like  dilation  of  blood 
vessels.  A  vascular  tumor. 

Aniridia.     Absence  of  or  defect  in  iris. 

Anisometropia.  A  difference  in  the  refrac- 
tion of  the  two  eyes. 

Anisometropic.    Affected  with  anisometropia. 

Anisopia.    Unequal  visual  powers  of  the  eyes. 

Anisotropal.  Not  possessing  the  same  light 
refracting  properties  in  all  directions. 

Ankyloblepharon.  The  adhesion  of  the  ciliary 
edges  of  the  eyelids. 

Anopia.    Absence  of  sight. 

Anophthalmus.     Congenital  absence  of  eyes. 

Anorthopia.  Seeing  incorrectly;  straight 
lines  appear  bent. 

Anopsia.     Vertical  strabismus. 

Antagonist.  Counteracting.  A  nerve  and 
muscle  opposing  the  action  of  another 
set. 

Antero-posterior.  Extending  from  before 
backward. 

Aphakia.  Condition  of  an  eye  with  crys- 
talline lens  absent. 

Aplanatic.  Referring  to  lenses,  means  cor- 
rected of  spherical  and  chromatic  aber- 
ration. Also  apochromatic. 

Appendage.     To  hang.     The  eye-lids,   etc. 

Apperception.  To  receive  sensory  impres- 
sions. 

Applanatio  Comae.  A  flattening  of  the  cor- 
nea from  disorder. 

Arachnoid.  A  spider's  web.  The  mem- 
brane of  brain  between  Dura  and  Pia 
mater. 

Arcus  (Senilis).  A  cloudy  ring  near  edge 
of  cornea  in  old  age. 

Asthenia.    Absence  of  strength.    Adynamio. 

Asthenopia.  Weakness  of  the  ocular  nerves 
or  of  visual  power. 

Astigmatic.  Pertaining  to  or  affected  with 
astigmatism. 

Astigmatism.  That  condition  of  the  eye  in 
which  rays  of  light  do  not  converge  to  a 
common  point  on  the  retina. 

Astigmatometer.  An  instrument  for  ap- 
proximating the  degree  of  astigmatism. 

Atheroma.     A  sebaceous  cyst. 

Atresia.     Imperforation  of  pupil. 

Atrophy.     Degeneration  from  any  cause. 

Atropina.  One  of  the  Fates  who  cut  the 
thread  of  life.  Atropabelladonna  or 
deadly  nightshade.  A  cycloplegic. 

Auriscope.  An  instrument  for  examining 
the  ear. 

Axis.  An  imaginary  line  passing  through 
the  center  of  the  eye. 

Axis-cylinder.  The  conducting  or  essential 
part  of  a  nerve. 

Basedow's   Disease.     Exophthalmic  goiter. 


306 


GLOSSARY 


Belladonna.     See  Atropina. 

Binocular.     Pertaining  to  both  eyes. 

Biology.  The  structure,  organization  and 
functions  of  life. 

Biorbital.     Relating  to  both   orbits. 

Blepharadenitis.  Inflammation  of  the  Mei- 
bomian  glands. 

Blepharitis.     Inflammation  of  the  eyelids. 

Blepharoadenoma.  An  adenoma  of  the  eye- 
.  lid. 

Blepharoatheroma.  A  sebaceous  cyst  of  the 
eyelid. 

Blepharochromidrosis.  Colored  sweat  of  the 
eyelids,  usually  of  a  bluish  tint. 

Blepharophimosis.  Abnormal  smallness  of 
the  palpebral  aperture. 

Blepharoplasty.  An  operation  for  the  re- 
storation of  any  part  of  the  eyelid. 

Blepharoplegia.     Paralysis  of  an  eyelid. 

Blepharoptosis.    See  Proptosis. 

Blepharorrhaphy.     Stitching  the  eyelids. 

Blepharospasm.  A  spasm  of  the  orbicularis 
palpebrarium. 

Blepharostat.  An  instrument  for  holding 
eyelids  apart  during  operation. 

Blepharostenosis.  Narrow  space  between 
eyelids. 

Blepharosynechia.  Adhesion  of  edges  of  eye- 
lids. 

Blepharotomy.     To  cut  into  the  eyelids. 

Blind  Spot.     The  optic  disk. 

Bonnet's  Capsule.     See  Tenon's  capsule. 

Buphthalmos.     Enlargement  of  eyeballs. 

Canal.     A   tubular   channel   or   passage. 

Canthus.    Angle  formed  by  eye-lids. 

Cardinal.     Pre-eminent. 

Caruncle.     A  small,  fleshy  growth. 

Casein.     Cheese. 

Catamenia.  Refers  to  the  monthly  period  of 
menstruation. 

Cataract.  (A  waterfall).  An  opacity  of  the 
crystalline  lens  misnamed. 

Catarrh.  To  flow  down.  Infection  of  nasal 
passages  and  other  parts. 

Catoptric  Test.  A  diagnosis  of  cataract  by 
means  of  the  reflection  of  images  from 
the  cornea  and  lens-capsules. 

Catoptrics.  The  laws  of  the  reflection  of 
light. 

Centimeter.    One-hundredth  part  of  a  meter. 

Centrad.    Toward  the  center. 

Ceratitis.     Inflammation  of  cornea. 

Chernosis.     A  swelling  of  the  conjunctiva. 

Chiasm.     The  optic  commissure. 

Chlorosis.  General  debility  in  young  women 
from  menstrual  disturbances. 

Chorea.  _  St.  Vitus's  dance. 

Chromatic.     Color. 

Chromatopsia.     Colored  vision. 

Cicatrix.     A  scar. 

Cilia.    The  eyelid  or  lash. 

Ciliary.  Pertaining  to  the  eyelid  or  eyelash. 
Also  to  the  mechanism  of  accommoda- 
tion. 

Clonic.  Commotion.  Periodic  nervous 
spasm. 

Collyrium.     An  eye  lotion. 

Coloboma.    A  mutilation. 

Complemental.  Increasing  the  value  or  po- 
tency of  one  thing  by  adding  another. 

Conjunctiva.  The  mucous  membrane  cover- 
ing the  front  of  the  eye  and  lining  the 
lids. 


Conjunctivitis.  Inflammation  of  the  con- 
junctiva. 

Copiopia.     Eye-strain. 

Corectopia.     Pupil  misplaced. 

Coredialysis.  Creation  of  an  artificial  pupil 
by  operation. 

Corelysis.     Detachment  iris-lens   adhesions. 

Coremorphosis.     Same  as  coredialysis. 

Coreometer.    To  measure  pupils. 

Cornea.  The  transparent  anterior  portion  of 
the  eyeball. 

Corneitis.     Inflammation  of  cornea. 

Corrugator.  To  wrinkle.  The  pyramidal 
muscle  connecting  the  eyebrows  which 
causes  vertical  wrinkles  in  the  forehead, 
between  the  eyes — a  symptom  of  hyper- 
opia. 

Crystalline.     The  lenticular  humor  of  eye. 

Cuneus.  •  Wedge-shaped  convolutions  on 
mesial  aspect  of  occipital  lobes.  Or- 
igin of  optic  nerves. 

Cyclitis.  Circle.  Inflammation  of  ciliary 
body. 

Cyclophoria.  Improper  nerve  supply  to  ob- 
lique muscles. 

Cycloplegia.  Paralysis  of  accommodation  of 
eyes. 

Cyclops.  A  congenital  malformation  con- 
sisting in  a  fusion  of  the  two  eyes  into 
one. 

Cyclotomy.  An  operation  alleged  to  be  for 
the  relief  of  glaucoma. 

Cyst.    A  pouch.    A  tumor. 

Dacryoadenitis.  Inflammation  of  the  lachry- 
mal gland. 

Dacryocystitis.  Inflammation  of  the  lachry- 
mal sac. 

Dacryolith.  A  stony  deposit  in  the  lachry- 
mal passage. 

Dacryoma.  Overflow  of  tears.    Also  epiphora. 

Dacryops.     A  watery  eye. 

Dacryocystotome.  Instrument  for  cutting 
•strictures  of  lachrymal  passages. 

Dacryocystoblenorrhea.  Inflammation  and 
suppuration  of  lachrymal  apparatus. 

Daltonism.     Color  blindness. 

Dance.     St.  Vitus'     Also  chorea. 

Day-blindness.  See  Nyctalopia;  also  Hemer- 
alopia. 

Descemet's  Membrane.  The  elastic  mem- 
brane lining  the  posterior  surface  of  the 
cornea. 

Dextrad.    Toward  the  right  side. 

Dialysis.  Passing  of  liquid  through  a  mem- 
brane. 

Diathesis.     A  condition. 

Didactic.  Teaching  by  description  and  the- 
ory. 

Diffraction.  Displacement  of  light  as  it 
passes  a  narrow  opening. 

Diffusion.  A  spreading  out.  Circles  of  dif- 
fusion. Not  points  of  light. 

Diopter.  To  see  through.  Used  as  a  unit 
of  measure  of  lenses. 

Dioptric.  Pertaining  to  transmitted  and  re- 
fracted light. 

Diplopia.     Double  vision. 

Disc.    Circular. 

Discission.    A  tearing  operation  for  cataract. 

Distichiasis.  A  double  row  of  eyelashes  on 
one  lid.  See  Entropion. 

Dyne  Power.    A  measure  of  force. 

Dysmenorrhea.     Painful  menstruation. 


GLOSSARY 


307 


Ecchymosis.     Black  eye. 

Ectropion.  Ectropium.  A  turning  out  of 
the  edges  of  eyelids. 

Efferent.  Carrying  from ;  opposite  to  affer- 
ent. 

Emansio.  Delay  of  first  appearance  of 
menses. 

Embolism.  Plugging  of  a  vessel.  See 
thrombus. 

Emmetropia.  Xormal  or  perfect  refraction 
of  eye. 

Enophthalmos.    Recession  of  eyes  into  orbits. 

Enteric.     Pertaining  to  intestines. 

Entropion.  Entropium.  A  turning  in  of  the 
edges  of  the  eyelids. 

Enuresis.     Involuntary  emptying  of  bladder. 

Epilation.     The  extraction  of  hairs. 

Epimysium.    The  sheath  of  a  muscle. 

Epiphora.     Overflow  of  tears. 

Episcleral.  Situated  on  the  outside  of  the 
sclerotic  coat. 

Erythropsia.  A  condition  in  which  every- 
thing appears  red. 

Esophoria.     Inward  tending  of  optic  axes. 

Esotropia.  Convergent  strabismus. 

Euphoria.    A  healthy  condition. 

Exophoria.    Outward  tending  of  optic  axes. 

Exophthalmos.  Abnormal  prominence  of  the 
eyeballs. 

Exotropia.     Divergent  strabismus. 

Extravascular.     Outside  of  the  vessels. 

Far  Point.  The  most  distant  point  at  which 
an  eye  can  see  distinctly  when  accommo- 
dation is  completely  relaxed.  Only  my- 
opes have  far  points. 

Far  sightedness.    Hypermetropia. 

Fixation.  The  act  of  fixing  with  the  eyes 
•on  an  object. 

Follicle.    A  small  sac. 

Fovea  centralis.  The  point  where  the  axis 
of  the  eve  ends  at  the  macula. 

Foramen.     A  hole. 

Franklin  Spectacles.  Bifocal  lenses.  Named 
after  B.\  Franklin,  their  inventor. 

Glaucoma.      A    sequel    of    chronic    cyclitis. 

Glioma.     Retinal  tumor. 

Gerontoxon.     Arcus  senilis. 

Goiter.  Enlargement  of  the  thyroid  gland. 
Exophthalmic  goiter,  includes  a  protru- 
sion of  eyes. 

Grando.     Chalazion. 

Grattage.  Removal  of  granulations  from 
conjunctiva  with  a  brush. 

Graves's  Disease.     Goiter. 

Gutta  opaca.  Arabian  name  for  cataracts. 
Drop,  opaque. 

Gynecology.    The  sex  ills  of  women. 

Hemeralopia.  Xight-blindness.  See  day- 
blindness. 

Hemiachromatopsia.  Color-blindness  in  half 
the  field  of  vision. 

Heliophobia.  Fear  of  light.  Painful  vision. 
Photophobia. 

Heterochromia.     Different  colored  irises. 

Heteronvmous.    On  opposite  sides. 

Heterophoria.  A  tendency  of  the  eye  axes 
to  depart  from  parallelism. 

Hippus.     Spasmodic  action  of  pupils. 

Holmgren's  Test.    A  test  for  color  blindness. 

Hordeolum.     A  stye. 

Horopter.  Boundary  of  field  of  vision  with 
eyes  stationary.  • 


Humor.    Fluids  of  body. 

Hyaloid.     Transparent. 

Hygiene.     Good  for  the  health. 

Hyperemia.     Excessive  blood  in  a  part. 

Hypermetropia.     Same  as  hyperopia. 

Hyperopia.     Farsight. 

Hyperphoria.  Tendency  to  vertical  devia- 
tions of  axes  of  eyes. 

Hypertrophy.  Excessive  development  of  a 
part,  usually  from  nervous  irritation  and 
congestion  of  blood. 

Hypometropia.  Vision  below  normal.  My- 
opia. (A  poor  definition). 

Idiopathic.     An  ill  originating  in  one's-self. 

Idiosyncrasy.  Special  or  peculiar  characteris- 
tic. 

Image.    A  likeness. 

Incoordination.  Inability  to  produce  volun- 
tary muscular  movements  in  proper  or- 
der or  sequence. 

Infraorbital.     Below  the  orbits. 

Interorbital.     Situated  between  the  orbits. 

Intravascular.     Within  the  blood  vessels. 

Iridal.     Pertaining  to  the  iris,  or  irides. 

Iridectomy.  Cutting  out  of  a  part  of  the 
iris. 

Tridencleisis.     See  iridodesis. 

Irideremia.     Absence  of  one  or  both  irides. 

Iridesis.     See  iridodesis. 

Iridochoroiditis.  'Inflammation  of  both  the 
iris  and  the  choroid  of  the  eye. 

Iridocyclitis.  Inflammation  of  the  iris  and 
the  ciliary  body. 

Tridodesis.     A  binding  together. 

Iridodialysis.     See  coredialysis. 

Iridodonesis.     Trembling  of  iris. 

Iridoplegia.     Paralysis  of  iris  splincter. 

Iridotomy.    An  incision  into  the  iris. 

Iris.     A  halo  or  rainbow. 

Iritis.     Inflammation  of  iris. 

Isocoria.    Pupils  of  equal  size. 

'Tsomeric.     Composed  of  same  elements. 

Isomorphic.    Having  the  same  form. 

fsophoria.     Same  as  orthophoria. 

Jacob's  Membrane.  The  layer  of  rods  and 
cones  of  the  retina. 

Keratectasia.  A  bulging  forward  of  the  cor- 
nea. 

Keratitis.     Inflammation  of  the  cornea. 

Keratoconus.  A  conical  protrusion  of  the 
cornea. 

Keratoglobus.  A  globular  protrusion  of  the 
cornea. 

Keratomalacia.    A  softening  of  the  cornea. 

Keratome.  A  knife  used  for  making  cor- 
neal  incisions. 

Keratometer.  An  instrument  for  measuring 
curves  of  the  cornea.  Ophthalmometer. 

Keratomycosis.  A  fungoid  growth  of  the 
cornea. 

Keratonyxis.  Needling  of  a  soft  cataract 
through  the  cornea. 

Keratoplastv.  Transplantation  of  cornea. 
Never  has  been  done. 

Keratoscope.  An  instrument  for  examining 
the  cornea.  Oohthalmometer. 

Keratotomy.     Incision  of  the  cornea. 

Kopiopia.     Eve  exhaustion  from  excess  use. 

Lachrymal.     Pertaining  to  tears. 

Lacus-lachrymalis.  The  space  at  inner  angle 
of  eye  where  tears  are  delivered  to  lach- 
rvmal  canal. 


308 


GLOSSARY 


Lagophthalmos.    Inability  to  close  eyes  prop- 
erly. 

Lamella.    A  thin  scale  or  plate. 

Lamina.      Same   as   Lamella.     Lamina   crib-, 

rosa  is  a  perforated  plate  at  optic  disk 

to  admit  optic  nerve  branches. 
Lens.    A  transparent  substance  for  refraction 

of  light  to  or  from  a  focus. 
Lesion.      A    product    of    injury    or    morbid 

structural  change. 

Leucoma.    A  white  tumor  on  cornea. 
Leukemia.     Increase  of  white  corpuscle,  en- 
largement of  spleen,  etc. 
Leukorrhea.     A  whitish  discharge   from  the 

vagina. 

Limitans.     Certain  membranes  of  the  retina. 
Lippitudo.     Falling  of  lashes. 
Lumbago.     Pain  in  the  loins. 
Lupus.     A  granulation   of   skin   and   mucus 

membrane.  . 
Macroscopic.     Large   enough  to  be  seen  by 

the  naked  eye. 
Macula.      A  spot.       The     field    around    the 

optic  axis  where  images  are  formed. 
Malacia.     Softening  of  tissues. 
Megalopsia.    Objects  appear  larger  than  they 

are. 

Meniscus.    A  crescent. 
Menopause.     Cessation  of  menstruation. 
.Menorrhagia.     Excessive  menstrual  flow. 
Menorrhea.     Normal  flow  of  menses. 
Menses.    The  recurrent  monthly  discharge  of 

blood  from  the  genital  canal  of  a  woman 

during  sexual  life. 
Menstruation.    Same  as  menses. 
iMetaboHsm.     Chemical  body  changes.     Ana- 

bolism    to    build.      Katabolism    to    tear 

down. 

Metamorphopsia.     Seeing  objects  misshapen. 
Metrorrhagia.       Uterine    hemorrhage     inde- 
pendent of  the  menstrual  period. 
Microscope.     An   instrument 'through  which 

objects  not  visible  to  the  naked  eye  may 

be  examined. 

Miosis  or  Myosis.     Contraction  of  pupils. 
Miotic  or  Myotic.     Pertaining  to  miosis. 
Monochorea.     Oscillation  limited  to  one  eye. 
Monocle.     A  lens  for  one  eye  only. 
Monocular.     Pertaining  to  or  affecting  only 

one  eye. 
Morphology.    Form  and  structures  of  organic 

life. 

Muller's    Muscles.      Small    bundles    of   non- 
striped   muscle  in   the  upper  and  lower 

lids.    Ciliary  sphincters. 
Muscre  volitantes.    Floating  specks  before 

eyes. 
Muscles.      Structures    composed    of    striped 

and  smooth  tissue  supplied  with  cells  for 

innervation  and  activity. 
Mydriasis.    Dilation  of  the  pupil  of  the  eye. 
Myopic.     Near-sighted. 
Myosis.     Contraction  of  pupils. 
Naevus.     A  mole. 
Near-point.     The    point   nearest   the   eye   at 

which   an   object  can   be   seen   distinctly 

by  accommodating. 
Needling.     Process  of  lacerating  a  cataract 

with  a  needle. 
Neura.  Nerve. 
Neural.  Pertaining  to  nerves  or  nervous 

tissue. 
Neurasthenia.     Nerve  weakness. 


Nicol's  Prism.  A  specialty  constructed 
prism  combination  which  reflects  ordi- 
nary light,  while  the  "polarized"  ray  is 
transmitted. 

Nictitation.     Winking. 

Nocturnal.    Night. 

Nodal.  A  node,  or  knob.  The  nodal  points 
of  lens  systems  are  where  secondary 
axial  rays  would  cross  the  axis  if  they 
did  not  suffer  refraction. 

Nyctalopia.  Night  vision.  See  Hemeral- 
opia. 

Nystagmus.  An  oscillation  or  dancing  of  the 
eyes.  See  chorea. 

Objective.  The  part  of  a  microscope  far- 
thest from  the  eye.  A  method  of  exam- 
ining eyes. 

Ocular.     Pertaining  to  the  eye. 

Oculist.  _  An  M.  D.  who  malces  the  eyes  a 
specialty  without  any  training  in  physi- 
cal optics  or  other  essentials. 

Oculomotor.  Pertaining  to  the  movement 
of  the  eye. 

Oculus.     An   eye. 

Oculozygomatic.  Pertaining  to  the  eye  and 
the  zygoma. 

Ophthalmia.     Inflammation  of  the  eye. 

Ophthalmic.     Pertaining  to  the  eye. 

Ophthalmitis.     Inflammation  of  the   eye. 

Ophthalmoblennorrhea.  Blennorrhea  of  the 
conjunctiva. 

Ophthalmocele.     See  Exophthalmus. 

Ophthalmocopia.     Fatigue  of  retina. 

Ophthalmodonesis.  A  trembling.  Nystag- 
mus. 

Ophthalmodynia.     Neuralgia. 

Ophthalmologist.  One  versed  in  optics  and 
Ophthalmology  including  anatomy,  phy- 
siology and  the  nervous  relations  of  the 
eyes. 

Ophthalmology.  Science  of  the  eye  and  its 
capacity  for  disturbance  of  the  general 
nervous  system. 

Ophthalmomalacia.  Softness  of  eye  ten- 
sion. 

Ophthalmometer.  An  instrument  for  measur- 
ing astigmatism  approximately. 

Ophthalmometry.  Any  system  of  measuring 
eye  defects  that  works. 

Ophthalmopathy.     Any  "disease"  of  the  eye. 

Qphthalmophthisis.  A  shrinking  of  the  eye- 
ball. 

Ophthalmoplegia.  Paralysis  of  the  ocular 
muscles. 

Ophthalmoscope.  An  instrument  for  examin- 
ing the  interior  of  the  eye. 

Ophthalmostat.     A  speculum^ 

Optic.  Pertaining  to  vision  or  to  the  science 
of  optics. 

Optical.  Pertaining  to  sight  or  to  optical 
instruments. 

Optician.  A  maker  of  optical  lenses  and 
instruments. 

Opticociliary.  Pertaining  to  the  optic  and 
ciliary  nerves. 

Opticopupillary.  Pertaining  to  the  optic 
nerve  and  the  pupil. 

Optometer.  An  instrument  for  measuring 
errors  of  refraction. 

Optometrist.  An  optician  who  pretends  to 
fit  eyes  with  glasses. 

Orbicular.     Relating  to  circular  muscles. 

Orbit.  The  bony  pyramidal  cavity  contain- 
ing the  eye. 


GLOSSARY 


309 


Orthophoria.    A  normal  balance  of  the  eyes, 

axes  parallel  at  rest. 
Orthoptic.     Binocular  vision. 
Orthoscope.    An  instrument  for  examination 

of  the  eye  through  a  layer  of  water  to 

neutralize  the  cornea. 

Oxyopia.    Extraordinary  acuteness  of  vision. 
Pannus.     Vascular  covering  of  the  cornea. 
Panophthalmitis.      Inflammation    of    all    the 

tissues  of  the  eyeball. 
Pantoscopic.     See  Franklin  glasses. 
Papilla.     The  Optic  disk. 
Papillitis.    Inflammation  around  optic  disk. 
Paracentesis.     Puncture  of  cornea  or  other 

tissue. 

Parallax.      Apparent    displacement    of     ob- 
jects. 

Paramenia.      Difficult     or     disordered    men- 
struation. 

Pemphigus.     A  blister. 
Perimeter.      An    instrument    for    measuring 

the  field  of  vision. 
Perioptometry.      The    measurement    of    the 

limits  of  the  visual  field. 
Periorbita.       The     periosteum     of     the     eye 

socket. 

Periorbital.    Surrounding  the  orbit. 
Peristalsis.     The  nervo-muscular   movement 

of  vessels  and  tubes  of  the  body  which 

constricts  and  pushes  ahead.     Literally : 

around,  to  start. 

Petit  Canal.     Space  around  edge  of  crystal- 
line lens.     Assists  in  accommodation. 
Phlebitis.     Inflammation  of  a  vein. 
Phlyctenule.     A  little  vesicle  or  blister.     A 

granulation. 

Phlyctenular.     Resembling  a   phlyctenule. 
Photokinetic.     Causing  movement  by  means 

of  light. 
Photometer.     An  instrument   for  measuring 

the  intensity  of  light. 

Photometry.    Measurement  of  light  intensity. 
Photophobia.     Intolerance  of  light. 
Photopsia.       Seeing     stars     when     suddenly 

hurt. 
Pinguecula  or  Pinguicula.     Yellowish  white 

patches  on  conjunctiva  in  connection  with 

granulations. 

Pink-eye.     A  mucopurulent  conjunctivitis. 
Polycpria.     More  than  one  pupil. 
Polarization.     When  by  means  of  apparatus 

light  is  made    to    vibrate    in    only  two 

planes  at  right  angles  with  each  other  it 

is  said  to  be  polarized. 
Presbyopia.     Vision  of  old  age. 
Prism.    A  wedge. 
Prismatic.     Dispersive   effect  on   light  by   a 

prism. 
Prisoptometer.      An    optometer    made    with 

prisms. 
Prognosis.     Prediction   as  to   outcome   of  a 

trouble. 
Pterygium.     A  wing.     A  vascular  thickening 

of  the  ocular  conjunctiva. 
Ptilosis.    Falling  out  of  lashes. 
Ptosis  or  proptosis.     A  falling  of  the  upper 

lids. 

Punctum.     Point. 
Pupil.     The  aperture  of  the  iris  of  the  eye 

for  the  passage  of  light. 


Pupilloscopy.  Skiascopy.  Koroscopy.  Ret- 
inascopy.  The  shadow  test. 

Quiz.    To  ask. 

Radial.  As  the  spokes  of  a  wheel  from  the 
hub. 

Refract.     To  break. 

Refractometer.  An  instrument  for  measur- 
ing approximately  the  refraction  of  the 
eye. 

Refrangibility.  Capability  of  undergoing  re- 
fraction. 

Retina.     A  net.     The  visual  portion  of  eye. 

Retinitis.     Inflammation  of  the  retina. 

Retinochoroiditis.  Inflammation  of  the  retina 
and  choroid. 

Retinascopy.  The  shadow  test  for  refractive 
errors  by  the  employment  of  a  mirror. 

Scheiner's  Experiment.  An  experiment  il- 
lustrating refraction  and  accommodation 
of  the  eye  with  two  pinholes  in  a  card. 

Schematic.    A  proportional  drawing. 

Schlemm,  Canal  of.  A  channel  within  the 
sclera  close  to  the  corneal  juncture, 
whereby  the  aqueous  humor  finds  its  way 
into  the  general  circulation. 

Sclera..    The  sclerotic  coat  of  the  eye. 

Sclerectomy.  Excision  of  a  portion  of  the 
sclera. 

Scotoma.     Darkness.     Spot  before  the  eyes. 

Sinistrad.     Toward  the  left. 

Skiascopy.     Shadow.    Retinascopy. 

Snellen's  Types.     See  Test  Types. 

Soemmering's  Yellow  Spot.  The  macula 
lutea.  There  is  no  yellow. 

Spectacles.    A  pair  of  lenses  set  in  a  frame. 

Spectral.     Pertaining  to  a  spectrum. 

Spectrometer.     Measure  of  spectrum. 

Spectroscope.  An  instrument  for  the  pro- 
duction and  examination  of  the  spec- 
trum. 

Spectrum.  The  band  of  colors  produced  by 
a  prism. 

Speculum.  An  instrument  to  hold  eyelids 
open  during  operation. 

Sphygmomanometer.  An  instrument  for 
measuring  blood  pressure. 

Staphyloma.  A  bulging  of  the  cornea  or 
sclera  of  the  eye. 

Static.     Natural  condition.    To  stand  at  rest. 

Stenopeic.     Slotted,  disc. 

Sthenic.     Strong. 

Stethoscope.  An  instrument  for  examining 
lungs  and  heart. 

Stigma.     Point. 

Sti.ematic.      Pertaining  to  a  stigma. 

Stillicidium  lacrymarum.     Same  as  epiphora. 

Strabismus.     Squint.     Cross  eyes. 

Struma.     Scrofula.     Goitre. 

Stye.  A  cystic  tumor  on  the  edge  of  the 
eyelids.  A  Meibomian  cyst. 

Supraorbital.    Above  the  orbit. 

Smyblepharon.     Adhesion  of  lids  to  eye-ball. 

Synchysis.  Bright  particles  in  the  vitreous 
humor. 

.Svndesmitis.     Inflammation  of  a  ligament. 

Svnechia.     .Adhesion  of  iris  and  lens. 

Synergic.     Co-operative. 

Synergist.  One  nerve  co-operating  with  an- 
other. An  assistant. 


310 


GLOSSARY 


Synizesis.    Closure  of  pupillary  space. 
Tarsal.     Pertaining  to  the  cartilages  forming 

the  eyelids. 
Tarsoplasty.      Plastic    (molded)    surgery   of 

the  eyelid. 

Tarsorrhaphy.     Sewing  the  eyelids  together. 
Tenon,  Capsule  of.    A  fibroelastic  membrane 

surrounding    the    eyeball.      Also    called 

Bonnet's. 

Tenonitis.      Inflammation    of    Tenon's    cap- 
sule. 
Test  Types.     Printed  cards  for  testing  visual 

acuteness. 

Thrombus.    A  plug  or  blood  clot  in  a  vessel. 
Trichiasis.     "Wild  hairs"  in  the  eyes.    Ever- 

sion  of  lids. 


Trigeminal.     Triple.     Pertaining  to  the  fifth 

cranial  nerves. 
Trigeminus.     The   trifacial  nerves,   or   fifth 

cranial. 
Uniocular.    Pertaining  to  or  performed  with 

one  eye. 
Uveal   tract.     The  choroid,    iris   and   ciliary 

body. 

Vitreous.     Glassy. 
Xanthelasma.       Yellowish     discoloration     of 

eye-lids. 

Xerosis,  or  Xerophthalmos.    Dry  eye. 
Xerophthalmia.     Dry  eye. 
Zygoma.    The  cheek  bone.    The  arch  formed 

by   the   union   of   the   malar   bone   with 

the  zygomatic  process   of  the   temporal. 


PREFIXES,  SUFFIXES,  ABBREVIATIONS 


Prefixes  and  Suffixes 


PREFIXES. 

A-,  or  an-,  or  am-,  means  the  same  as  un-, 
in-,  or  im-. 

Ana-,  up,  through,  again. 

Ant-,  or  anti-,  against,  or  opposite  to. 

Apo-,  from. 

Bi-,  two. 

Contra-,  against. 

Dia-,  through. 

Dys-,  difficult,  painful,  defective. 

EC-,  ecto-,  or  ex-,  away  from,  outside. 

Em-,  en-,  in. 

Endo-,  ento-,  internal. 

Entero-,  intestine. 

Epi-,  upon,  over. 

Extra-,  outside. 

Gastro-,  the  stomach. 

Haema-,  haemo-,  or  haemato-,  blood. 

Hemi-,  half. 

Hetero-,  abnormal. 

Hydro-,  water. 

Hyper-,  over,  above,  beyond. 

Hypo-,  below. 

Hyster-,  relating  to  the  womb. 

Im-,  in-,  negative,  as  impossible  or  invol- 
untary; it  sometimes  means  within. 

Infra-,  beneath. 

Inter-,  between. 

Intra-,  inside. 

Leuco-,  white. 

Lith-,  relating  to  stone. 

Macro-,  large,  to  see  with  naked  eye. 

Melano-,  pigmentation. 

Meso-,  middle. 

Meta-,  after. 

Micro-,  small,  not  visible  to  naked  eye. 

Mon-,  single. 

Multi-,  many. 

Myelo-,   referring  to  brain   or  spinal  cord. 

Myo-,  muscle. 

Neuro-,  nerve. 


Odonto-,  tooth-like. 

Oligo-,  lack  of. 

Ophthalmo-,  eye. 

O'Steo-,  bone. 

Oxy-,  oxygen  or  acidity. 

Para-,  through  or  near. 

Peri-,  around. 

Poly-,  many. 

Pro-,  for,  before. 

Pseudo-,  false. 

Pyo-,  pus. 

Pyr-,  or  pyro-,  fire,  inflammation,   fever. 

Retro-,  backward  behind. 

Sub-,  under. 

Super-,  or  supra-,  above. 

Sym-,  or  syn-,  together,  the  same. 

SUFFIXES. 

-aemia,  condition  of  blood, 
-agogue,  to  carry  away, 
-agra,  an  attack, 
-algia,  pain. 

-cele,  a  hernia  or  protrusion,  tumorous. 
-ectomy,  to  cut. 
-graph,  to  write, 
-itis,  inflammation, 
-logy,  discourse, 
-malacia,  soft, 
-mania,  madness, 
-odynia,  pain, 
-oid,  form, 
-oma,  tumor. 

-opia,  relating  to  condition  of  eye. 
-pathy,  relating  to  diseases  and  their  cure, 
-phobia,  fear, 
-plasty,  to  form, 
-raphy,  a  suture, 
-rhagia,  to  burst  forth, 
-rhoea,  to  flow, 
-scopy,  to  see. 
-tomy,  to  cut. 
-uria,  referring  to  urine. 


Abbreviations — Ophthalmology 


Ace.  Accommodation. 

Am.  Ametropia. 

Amb.  Amblyqpia. 

As.  Astigmatism. 

P.  Prism. 

B.  D.  Base  down  (prism). 

B.  I.   Base   in    (prism). 

B.  O.  Base  out   (prism). 

B.  U.     Base  up   (prism). 

Cyl.  Cylinder. 

Cm.  Centimeter. 

D.  Diopter. 

Em.  Emmetropia. 

F.  Formula. 

Hor.  Horizontal. 

Hy.  Hyperopia. 

L.   Left  eye. 

M.  Meter. 

Mm.  Millimeter. 

My.   Myopia. 

O.  D.  Oculus  dextra. 

O.  S.  Oculus  sinistra. 

Pp.  Punctum  proximum   (near  point). 

Pr.  Punctum  remotum    (far  point). 

R.  Right  eye. 

Sph.  Spherical. 

Sym.  Symmetric. 


V.  Visual  acuteness. 

-f-  Plus    (positive). 

—  Minus  (negative). 
=  Equal,  parallel. 

oo  Infinity. 

O  Combined. 

Degree. 

|  Vertical. 

Horizontal. 

X.  Obliques. 

X+  Perpendiculars. 

ft  Paragraph. 

,  Comma. 

;  Semicolon. 

:  Colon. 

.  Period. 

?  Interrogation. 

!  Exclamation. 

•|  A  -(-  impulse. 

|-  A  —  impulse. 

—  Right  hyperphoria. 
-r-  Right  cataphoria. 

—  Hyper-esophoria. 

—  Hyper-exophoria. 

—  Cata-esophoria. 
— r  Cata-exophoria. 


'312  A  SYSTEM  OF  MATURE  MEDICINE 

ALPHABETICAL  SUBJECT  INDEX 

Abbreviations,    Ophthalmology    311 

Alleged  "Diseases"  of  the  Eyes.     Their  Causes  and  Treatment  189 

Anatomy  and  Physiology  of  the  Eyes  and  Their  Appendages  127 

Anatomy  and  Physiology  of  the  Nervous  System  119 

Appendix,    Paragraphic    Information    279 

Color  Sense.     Color  Ignorance.     Color  Blindness    255 

Cyclophoria  as  a  Cause  of  Apparent  Oblique  Astigmatism  171 

Errors  of  Refraction  in  the  Eyes.     How  They  are  Compensated  for  143 

Eponymes,    Ophthalmology    299 

Exercises  Involving  the  Principles  of  Physical  Optics   107 

Fitting  Spectacle  Frames  an  Important  Matter  223 

General  Disorders,  Symptoms  of  which  are  called  "Diseases"   225 

Glossary  of   Ophthalmological   words 305 

Heterophoria  as  a  symptom  of  Errors  of   Refraction   181 

Heterotropia.     How  to  Treat  it  without  Prisms  or  Operations    185 

Human  Ills  and  Their  Causes,  Viewed   from  a  Rational  Standpoint   241 

Idiosyncrasies  of   "Eminent"  Authors    265 

Idiosyncrasies  of  People  in  Professions  and  Trades   271 

Index,   General 313 

Neurometric  Method  of  Analysis  of  Cases    155 

Neutralization  of  Lenses,  Prescription  Writing  and  Transposition    87 

Objective  and  Subjective  Methods  Employed  in  Eye  Testing  205 

Physical  Construction  of  the  Eyes.     Standard  and  Defective  93 

Physics  of  Retinoscopy ;  why  it  will  not  work  Physiologically   101 

Physiognomy  and  Craniology  Indicate  Temperament  and  Disposition 261 

Physiology  of  Eyes  Used  to  Measure  Nerve  Supply  and  Demand   135 

Physiological  Action  of  Prisms  with  Proofs  of  Their  Unvalue    175 

Prefixes   and    Suffixes 311 

Preliminary    Remarks 5 

Refraction  by  plane,  parallel   Surfaces    13 

Refraction  by   Prisms • 21 

Refraction  and  Reflection  by  Single  Curved  Surfaces    .' .  29 

Refraction  and  Reflection  by  Piano-Convex  Lenses  . . . .' 41 

Refraction  and  Reflection  by  Piano-Concave  Lenses   51 

Refraction  and  Reflection  by  Bi-Convex  Lenses   57 

Refraction  and  Reflection  by  Bi-Concave  Lenses   •  . .   65 

Refraction  and  Reflection  by  Meniscus  Lenses   G9 

Refraction  and  Aberration  of  Tri-Curved  and  Other  Lenses 81 

Seeing,  Hearing,  Smelling,  Tasting,   Matters  of   Education    219 

Situation  in  Emmetropia  and   Ametropia,  without   Crystalline   Lens    217 


INDEX 


Aberration- 
Chromatic  83 
Spherical   34 
Mental   249 
Abscesses  225 
Absorption   20 
Accident   247 

Accommodation   137  to  300 
Acidity   of  stomach   227 
Achromatic  26  to   85 
Action   of   Prisms    175 
Addition    for    Hyperopia    158 
Addition    for    -}-,  impulse    159 
Advertised   lenses    76   to   106 
Afferent    nerves    121 
Albuminuria   228 
Alcoholism    228 

Alleged    "Diseases"    189   to   240 
Alternating  squint   186 
A    M    A    (Medical   Trust)    208 
Amenorrhoea  208,    228 
Amount  of  refraction  14 
Amplitude  of  Accommodation  138 
Analysis   12,   87,   155,   238 
Anatomy  11,   119,  127,  205 
Anemia  228 
Angina   pectoris   229 
Angles — 

Alpha   and    Gamma   99 
Construction   22 
Deviation  22.   180 
Emergence   15 
Incidence    15,  130 
Minute    144 
Reflection    15 
Refraction   15 
Anisometropia  153,  284 
Answers   107,   116 
Anterior  of   lens   94 
Aorta   128 

Apexes    of   Prisms   21 
Aphakia    217 
Aphthae  229 
Aplanatic  lenses   85 
Apoplexy  229 

Appendages   of    Eyes   127,   133 
Appendicitis    230    - 
Appendix  279 

Approximate   calculations  98 
Aqueduct    of   Sylvius    122,   124 
Aqueous    humor    129,    Io2 
Arachnoid    122 
Arteries    123,    128 
Artificial    light    8 
Asthma   231 

Astigmatism   33,   91,  98,   148,  etc. 
Atropine   101 
Attraction    14 
"Authorities"    99,  265 
Author's  duality  263 
Automatic  accommodation   176 
Axes — 

Oblique    in    cyclophoria    171 
Oblique  in  lenses  88 
Optical   and   visual   135 
Principal   29  to   99 
Secondary    29  to  99 
Axial  line  27,  33 

B 

Base   curve  83 
Base  line  18  to  79 
Base   of   Prism   21 
Bi-concave  lenses  65  to  68 
Bi  convex    lenses    57    to    64 
Bi-focal    lenses    83   to   85 
Biliousness  231 
Black,    Dr.   William   L.    12 
Blanks    for    analysis    161 
Blanks    for   classification    160 
Bleeding  with    leeches   194 
Blood   poison   187 
Blood,   quality   and    quantity    197 
Blood   supply   of   eye   128 
Body,    ciliary   131 
Body,  elements   of  243 
Bones   of   orbits    127 


Bonnet's   capsule   127 
Books  5 

Breakfast  foods  225 
British   opinion  260 
Broughan  8 
Brows,  eye   133 
Bunions  231 
Burnett,    S.    M.   292 

C 

Calculations  13  to  116  etc. 
Calculi  232 

Canal  of  Petit  129,  131 
Canal  of  Schlemm  129,  etc. 
Capsule  of  Bonnet  127 
Capsule  of  Tenon  127 
Carbuncle   225 
Cardiac  muscles  134 
Cardinal   planes  44,   53 
Cardinal  points  44,   53 
Cardinal   principles    16 
Carelessness   287 
Carotid  arteries   128 
Cartilage,   tarsal   133 
Cataract   195 
Catarrh   232 
Caution  to  public   291 
Cavernous  sinus   128 
Cases,   classification   of  147 
Cases,   specimen   161   to   167 
Cataphoria  175 
Causes  of  ills  241,  251 
Causes,   contributing   125  to  186 
Cause,    primary   140   to   186 
Cement   bi-focals   83 
Center,   controlling  184 
Center,  optical  27  to  99 
Centralis,  fovea  132,  196 
Cerebellum    122 
Cerebrum   122 

Chambers,    anterior,    posterior    132 
Charity   264 
Chart,  astigmatic    152 
Cheek  262 

Chemical   causes  249 
Chemical    formulae,    glass    13 
Chemical  groups  121 
Chemistry   119 
Chess  272 
Chicago   firms   276 
Chin  262 
Choked  disc  198 
Chord-arc  method  17 
Chorea  232 
Choroid  130,  193 
Christian  "science"   208,  242 
Chromatic  aberration   83 
Ciliary  body  131,  193 
Circle  method  17 
Circle   of   Willis   123 
.  Cjrcle    of    Zir.n    130 
Circles,    value   of    71 
Circular  sinus  124 
Closed  tear  duct  203 
Cocaine    187,    207 
Code,   telegraph   220 
Color  sense   2"i 
Color  tests  258 
Commissure,    optic    126 
Comparison  of  figures  62 
Complementary    colors    257 
Compound    astigmatism   98 
Compound   lenses    49 
Concave  lenses  51  to  56 
Concave   mirrors   103 
Concomitant   squint   186 
Condition — 

Dynamic    185 

Of    patients    161 

Static   185 

Systemic   186 
Cones  and   rods  132 
Confessions  of  an  author  267 
Confusion  colors  259 
Congenital   cataract   195 
Congenital    ills    244 
Conjugate   foci   30  to   79 
Conjunctiva  133 


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A  SYSTEM  OF  MATURE  MEDICINE 


Oblique   muscles    268 
Oblongata    123 
"Old   man   Fog"   209 
One  minute   angle  144 
Operations,  criminal  202 
Opium  habit  207 
Ophthalmology   10  to  300 
Ophthalmologist   119 
Ophthalmometer  106 
Ophthalmoscope  106,  197 
Optical — 

Axes  99,   135 

Centers  29   to  99 

Density  14 

Firms  56,  276 

Journals  56 

Truths  5 
Optic  disc  132 
Optic   nerve  126 
Optic  neuritis   198 
Optics   13  to   116 
Optics,  diagram   of  9 
Order    of    presbyopia    153 
Organic    chemistry   119 
Organic   body   246 
Organic  ills   254 
Orthodox  '"freshies"   207 
Orthophoria  149 

P 

Pacchionian  body   122 
Palpebrae,   elevator   126 
Palpebrarum,    orbicularis    133  . 
Paralytic   squint   186 
Patients'    condition   161 
Penalty    235 

Period  of  variations  156 
Perpendicular-parallel  22 
Petit,   canal  of  129 
"Phenomena  of  vision"  221 
Physical   eye  93 
Physical   optics   13   to   116 
Physics,   defined  11 
Physics   of  retinascopy  101 
Physiognomy   261 
Physiology,    nervous   119 
Pia  mater   122 
Pin-hole   266 
Pituitary  body   122 
Planes,   cardinal   43 
Planes,  conjugate  30  to  79 
Plexuses,  nerve  121  to   125 
Plus  impulse  150  to  159 
Pneumonia  239 
Points — 

Cardinal  43 

Conjugate  30  to   79 

Focal  29  to  99 

Near  and  far  138  to  145 

Nodal  41  to  97 

Principal  44  to  53 

Rays    from   25 
Poles  of  eye  89 
Poly-want-to-uria  234 
Pons   Varolii  125 
Possible  results   152 
Posterior   chamber  132 
Posterior  staphyloma   132 
Power — 

Creative  119 

Cylinders,  all  degrees  64 

Eyes  93 

Lenses  44 

Pow-wow  with   mirrors  216 
Practice  and  theory  155 
"Precision"    instruments    of   106 
Preliminary   remarks  5 
Presbyopia  131,   153,  282 
Prescription   writing  87 
"Press   Bulletins,"  A  M   A   226 
Primary  cause  6,   140,    186 
Primary   colors   256 
Primary  meridian   172 
Principal   meridian   172 
Principals,    cardinal    16 
Prisms — 

Angles  of  21 

Construction   of   21 

Deviation  of  21 

Physiological   action    of   175 

Tests   with  149 
Progressive  myopia  201 
Pull,  negative  133 
Puncta    lachrymalia    133 
Punctum   proximum    89 
Punctum   remotum   89 


Ouality   197 
Quantity   197 
Questions   106 

R 

Radii  29  to  99 
Range  of  accommodation  138 
Ratio   of  indexes    14 
Rays,   lines   representing   15 
Real    ills   246 
Real   images  37 
Relation  of  special   senses  222 
Reflection  17  to  39 
Refraction — 

Denned   l.i 

Eyes  93 

Indexes   of   14 

Lenses  41   to  92 

Plane  surface   13  to  20 

Prism  21  to  27 

Reflection   17 
Registration  159 
Remarkable    "xperiments  283 
Results,   possible   152 
Retina — 

Em.,   Hy..    My.  89 

Layers    of    132 

Normal  196 

Retinal  arteries   128        i 
Retinascopy,   a  joke  168 
Retinascopy,    physics    of    101 
Retinitis    198 
Retreating  forehead   263 
"Rheumatism"    of    eye    194,    232 
Rods  and  cones  132 
Rules  14  to  99 

S 

Sac,   lachrymal   133 
Scales,   bi-focal  83 
Schlemm,    canal   of  129 
Sclera    129,    193 
Sebaceous   glands   13." 
Secondary    axes   37 
Second   object  142 
Secondary    meridian    172 
Sectional   eye   129 
Sections   of   rays   15 
Seeing  219 
Segments,   bi-focal  83 
Senile  cataract  190 
Sensation  121 
Shadow    movement    105 
Shadow   test  101 
Sheaths    126 
Shock,    mental   249 
Short    focus    29 
Single  curved  surfaces  29 
Single   perpendicular   19 
Sinuses  122 

Skeleton   bridge   measures   224 
Smallpox  232 
Smelling   219 
Spaces  of  Fontana  130 
Spasm,  nervous   149  to  171 
Spastic   squint   186 
Special    sense   125,    219 
Specimen   cases    161 
Sphincter  muscle  131 
Sphenoid,    wings   of   127 
Sphenoidal   fissure    127 
Spherical    aberration    34 
Sphere-cylinders   49 
Spherical  lenses  41  to  79 
Sphygmomanometer    211 
Spinal  nerves  121 
Spirit  of  plague   208 
Squint  186 
Standard  eye  93 
Stages   of  retinitis  199 
Standards    in   practice   285 
Staphyloma  132 
Statements,  false  44 
Static   condition   149 
Static  nerve   test  181 
Stenopaic   disc   151 
Stethoscope   211 
Strain,    mental    249 
Strain,   nerve   140,  247 
Striated    muscles    134 
Stye   133 

Supercillii.   corrugator   133 
Supply,    blood,   nerve,   of   eye   128 
Suppuration    140 
Supreme    Court  decision   254 
Sylvius,    aqueduct    of    122 


INDEX 


317 


Sylvius,  fissures  of  123 
Symptom   classification  162 
Sympathetic   system   121 
Syphilitic    retinitis   199 
"Synopsis  of   Neurology"   5 
System,   body  245 
System,   nervous  119 
Systemic   cataract   185 

T 

Tables,  neurometric  157  to  171 
Tapetum   nigrum    128 
Tasting  219 
Tear  duct,   closed  203 
Teeth  148,  262 
Telegraph   code  220 
Temperament    160 
Temporary  lenses   150 
Ten  causes  of  ills  242 
Tensor   tarsi  133 
Tentorium  122 
Tests — 

Cyclophoria   173 

Dot-and-line  180 

Duction   179 

Muscles  182 

Nerves   182 

Refraction  143,   205 
Test  types    144 
Tenonrs  capsule  127 
Theory    and   practice    155 
Therapy,   diagram   of   181 
Thickness  of  lenses  279 
Thrombolism   199 
Tinitis   aurium   236 
Tissues,   connective  127 
Tonic  spasm  154 
Toric  lenses  81,  281 
"Trachoma"    200 
Tract,  uveal  127 


Transposition  87 
Tri-curved    lenses     81 
Traumatic   cataract   195 
Trusts  6 
Tyndall  9 

U 

Ulceration  140 
Unfogging   157 
Units   of  measure  22  to  44 
Uveal  tract  127 

V 

Vaccination  208,  233,  254 
Vaccine,  hay  fever  293 
Variation,   periods    of   156 
Varolii,    pons    125 
Veins   123 

Vena   vorticosa    130 
Ventricles   122 
Vertebral   arteries    123 
Vigor   of  youth  154 
Virtual  objects   37,  67 
Vision,  classes  of  148 
Vision,   tests   of  148 
Visual   axes  99,   135 
Vitreous  humor  129 


Weakness,  nervous  149 
Willis,  'circle  of   123 
Wings   of  sphenoid   127 
Work,   extra  158 

Xerophthalmos  204 

Young  7_ 

Youth,  vigor  of   154 

Zinn,   circle  of  130 
Zinn,    zone   of  131 


W 


LIST  OF  ILLUSTRATIONS 

Page 

Perpendicular-parallel  method   of   measuring   refraction    15 

Circle  method  of  measuring   refraction 16 

Chord-arc  method  of   measuring  refraction    17 

Base-line   method    of    measuring   refraction 18 

Single  perpendicular  method  of  measuring  refraction    18 

Same  applied  to  several   refracting  media    19 

A  cross-eye   case    20 

Form    of    prism    21 

Angles  of  construction  and  of  deviation  of  prisms   22 

Same   by    baseline    method 23 

Showing  calculation  of  apex  of  angle   of   deviation    24 

Showing  apparent  displacement  of  objects  by  prisms   25 

Showing    dispersion    by   prisms    • 25 

Showing  how  dispersion   is  eliminated    26 

Two  combinations  of  prisms  in  one  drawing;  figures  apply  to  both    26 

Similar   drawing   showing  positive   and   negative    focuses    27 

Showing  how  prism   principles  are   involved  in  lenses    27 

A    cross-eye    case 28 

Refraction   by   single   curved   surfaces    • 32 

Focus  by  a  single  curved  surface 32 

Negative    focus  by   single  curved   surface,   reversed    33 

Different  focal  points  by  central  and  edge  rays 33 

First  and  second  principal   focal  distances  by  single  curved  surfaces   34 

Principal  focal  distance  by  reflection  from  concave  surface   '•'>'> 

Conjugate  focuses  by  single  curved,  convex  surface  35 

Guide-line    method   of    locating   conjugate  '  focal   points    36 

Conjugate    focus    by    reflection    from   concave   surface    36 

Formation  of  images  by  single  convex  surface   37 

Virtual  object,  reduced  by  single,  concave  surface  37 

Virtual    object,    enlarged    by    single,    convex    surface     38 

Formation  of  images  by  concave  mirrors   39 

Magnification   of    objects    seen   in   concave    mirrors    40 

Minification  of   objects   seen  in  convex   mirrors    40 

Refraction    by   plano-convex   lenses    41 

Same   with   variations •  42 

Perpendicular  method   of    locating   optical   centers    43 

Perpendicular-parallel   method  of  locating  optical   centers    43 

Negative  focus   by  reflection   from   convex    surface    43 

Showing  the  true  principal  focal  point  on  flat  side  of  plano-convex  lens   44 

Showing   relative    focal   distances    of    different   lenses    45 

Illustrating  "an  interesting  exhibit  in  conjugate  focuses"    47 

Law   of    single   curves   used    for   finding   conjugate    focuses    47 

Showing  segment  of  a  cylinder   48 

Showing  meridians  of  cylindrical  surfaces  differ  in  power  49 

Showing  forms  of  -4-  and  —  cylinders   • 50 

Refraction  by  plano-concave  lenses    51 

Showing  first  and  second  negative  focal  points  of  concave  lens    52 

Showing  ray  entering  flat  surface  of  —  lens  only  suffers  refraction  once   52 

Showing  optical  center,  nodal  point,  secondary  axis  of  concave  lens   53 

Conjugate  focus  by  reflection  from  plano-concave  lens   53 

Formation  of  image  by  reflection  from  plano-concave  lens  54 

Virtual  object  as  seen  through  a  .plano-concave  lens  54 

Refraction  by  bi-convex  lenses    57 

Refraction  and  formation  of  image  by  glass  globe  58 

•Principal  points  and  planes  of  a  bi-convex  lens   60 

Formation    of   images    by   bi-convex   lenses 60 

Showing  how  location  of  object  fixes  position  and  size  of  F2  62 

Showing  spherical  and  cylindrical  surfaces  of  a  bi-convex  lens  63 

Refraction   by  bi-concave  lenses • 65 

Optical  center,  nodal   points,  negative  principal  focuses  of  bi-concave  lenses    66 

Virtual  object  seen  through  a  bi-concave  lens   67 

Spherical  and  cylindrical  surfaces  of  a  bi-concave  lens   68 

Refraction  by  +   meniscus   lenses    « 69 

Refraction   by  —   meniscus   lenses    • 70 

Comparison  of  structures  of  -f-  and  —  meniscus  lenses  71 

Principal  focal  distances   of  a  -j-  meniscus  lens    73 


LIST  OF  ILLUSTRATIONS  319 


Page 

Principal  focal  distances,  negative,  of  a  —  meniscus  lens   74 

Details  of  calculation  for  a  +  meniscus  lens   75 

Details  of  calculation  for  a  —  meniscus  lens,  negative  focuses   76 

Advertised  lenses  shown  to  be  faulty  in  construction  77 

Conjugate  focal  distances  of  a  +  meniscus  lens   78 

Two    crosseye    cases 79 

Three    pictures    of    the    same    cross-eye    case    80 

Showing  a  true  tpric  surface,  sphere  and  cylinder  on  same  side  of  lens  81 

Comparison  of  bi-convex  and  meniscus  sphero-toric  lenses   82 

Comparison  of  meniscus  with   bi-convex  bi-focal  lens 84 

Showing  very  strong  lenses  could  not  be  made  meniscus  form  84 

Showing  the  same  proposition  as  could  be  made  bi-convex 84 

Showing  ordinary  form  of  meniscus  could  be'  made,  but  is  not  good    85 

Showing  several  forms,  surface  and  edge  of   freak  lenses    85 

A    cross-eye    case    86 

Protractor   for  finding  the   exact   axes  of  cylindrical  lenses    88 

Showing  principal  and  secondary  meridians  of  a  cylindrical  surface   89 

Emmetropia,   hyperopia  and   myopia 89 

Showing  myopia   is  the  only  condition  having  a  far  point    90 

Showing  the  focal  points  in  the  several  eye  defects    90 

Compound    hyperopia 91 

Showing   steps   in   correcting   the   above    • 91 

Mixed    astigmatism • 91 

Show-ing    steps    in    correcting    the    above    91 

Posterior   surface  of    crystalline   lens   and  its    focuses    93 

Anterior  surface   of   crystalline   lens   and   its   focuses    94 

The  crystalline  lens  as  a  whole,  with  its   focuses    94 

Crystalline  lens  enlarged,  beginning  construction  of  a  sectional  eye   95 

Showing   the   physical   construction   of    a   sectional    eye    96 

Retinascopy  with   plane   mirror ;    emmetropic   eye    101 

Same ;    hyeropic    eye 102 

Same ;   myopic  eye    103 

Same,  with  concave  mirror ;   emmetropic   eye 103 

Same ;  hyerpoic  eye    104 

Same ;    myopic    eye 104 

Retinascope  and  ophthalmometer    106 

Relation  between  eyes ;  arrangement  of  muscles   126 

Sectional    eye,    enlarged 129 

Mechanism  of  accommodation   137 

The  emmetropic  eye,  at  rest  and  accommodating   145 

The  hyperopic  eye.  at  rest  and  accommodating    146 

Same  with  correcting  lens  in  position    146 

The  myopic  eye,  showing  its  far  point  and  where  parallel  rays  focus  147 

Same  with  correcting  —  lens   in   position 147 

Astigmatic    chart,    reduced    152 

Cyclophoria  and  oblique  astigmatism,  simulated  in  spasm    171 

Same,    with    exhaustion    of    the    nerve    supply    172 

Same,  with  real  oblique  astigmatism,  but  out  of  position  from  spasm  172 

Same,  with  displacement  reversed  on  account  of  weakness   173 

Prism  chart  for  measuring  actual  deviations  of  the  eyes  under  i  static  test  175 

The    ophthalmoscope 188 

A    pterygium     188 

A    cataract 188 

A  normal   retina 196 

The   author's    ophthalmoscope    197 

A  case  of  neuro-retinitis    198 

Albuminuria     (2    pictures) 199 

An    embolism     199 

A    haemorrhage 200 

Cupped    disc 20O 

Image    in    emmetropic    eye 220 

Telegraph    code    220 

How   a  printer   reads   type 220 

Image  in  front  of  retina  in  myopia  221 

Image  would  be  behind  retina  in  hyperopia  "if  it  could  be  formed  221 


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